A 16-year-old horse was admitted to the clinic of the Department of Surgery and Anesthesiology of DomesticAnimals of the Faculty of Veterinary Medicine (Ghent University) for the treatment of a very large, nonhealingwound extending over the dorsomedial and dorsolateral aspects of the left metatarsus. Surgicaldebridement of exuberant granulation tissue and new bone was performed under general anesthesia, followedby standard wound care under a bandage. Once a new bed of healthy granulation had formed, skin graftingwas performed using the punch graft method. Due to the presence of a significant amount of wound exudate,cast immobilization was considered to be contraindicated. Instead, vacuum-assisted closure (VAC) therapy wasused as a method of securing the skin grafts to the wound bed during the first days post-operatively. After fivedays of VAC therapy, the wound dressing was removed and an acceptance of nearly 100% of the punch graftswas observed. Complete epithelialization of the wound was evident 42 days after skin grafting. As far as theauthors know, this is the first report describing the use of VAC therapy as a method of wound managementin combination with punch grafting on the distal limb of a horse.