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Negative-pressure wound therapy with instillation and dwell (NPWTi-d) is an option for management of wounds with exposed orthopedic fixation hardware. The mechanical effect of the negative-pressure therapy works to contract the wound edges, and the instillation of solution and its subsequent removal help remove infectious material. NPWTi-d also promotes robust granulation tissue formation. In this article, we discuss the science behind NPWTi-d and its role in the treatment of wounds with indwelling orthopedic fixation hardware. Negativ