Negative pressure wound therapy (NPWT) has evolved beyond its original design as a stationary, reusable system (traditional NPWT [tNPWT]) and is now also available as a single-use, portable device (sNPWT). No established guidance exists for selecting the appropriate system to treat specific wound types in various settings. This article reviews the current practice and challenges associated with NPWT. Relevant literature was reviewed to provide a background on current practice. An online quantitative survey was performed during October and November 2018 among users of NPWT based in acute care settings across 6 countries (Australia, France, Germany, Italy, the United Kingdom, and the United States) to elucidate the operational and financial components considered in determining and/or thwarting efficacious use of NPWT. Data from recruited participants were collected, analyzed, and tabulated by an independent research company. All findings were reported as numbers/percentages. Wound size and depth, as well as the amount and/or type of exudate, were found to be among key factors in selecting NPWT; patient quality of life in terms of mobility, independence, and attitude toward treatment may be factors in adherence with prescribed care. Clinicians were not consistently knowledgeable about the financial and operational challenges of utilization presented by large fleets of NPWT pumps, nor were other institutional employees such as payers and discharge planners. Evidence-based recommendations are needed to guide decisions regarding NPWT systems, which in turn may improve therapy implementation, access to care, and patient quality of life, while driving operational and financial efficiencies for health care providers.