Scissors are used to create fenestrations in the 10 × 10 drape to allow for outward egress of fluids. The Steri-Drape is then placed circumferentially under the fascia 2–3 in. from its edge, taking care to cover the abdominal viscera as an interface layer prior to placing overlying laparotomy sponges. The two laparotomy sponges are placed over the drape, taking care to cover the cut edges of skin and subcutaneous tissues to prevent desiccation. Two JP drains with their tips oriented in a caudad direction. A sterile towel is shaped to fit over the entire wound. The abdominal wall should then be cleaned and dried, and an adhesive such as Mastisol or Benzoin is generously applied to the skin surrounding the wound. Following this, an Ioban dressing is placed over the entire abdomen. Care must be taken to ensure a good seal of the Ioban dressing to the skin, particularly, in the problematic contours of the suprapubic and inguinal regions, because an inadequate seal in these areas will result in leaking of intra-abdominal fluid and failure of the vacuum dressing. A “mesentery” is created at the top of the vac pack for each JP drain by “tubulizing” the Ioban drape around each drain as the drape is secured. The JP drains are then placed to 100–125 mm Hg continuous wall suction creating a negative pressure system that serves to minimize fascial retraction and loss of abdominal domain [5]. The obvious advantage of using this method is that it is easy and quick to apply, especially in the damage control setting. The most common complications (see Chap. 8) are fistula formation (5–7 %), intra-abdominal abscesses (4–6 %), and delayed small bowel obstruction (4 %). Mean closure times are between 6–10 days with reported primary fascial closure rates of 70–80 %. One criticism of this method is the lack of consistent measured applied negative pressure which tends to be much less than the set pressure of 100–125 mm Hg.