This article describes the successful use of topical negative pressure (TNP) therapy to treat small-bowel fistulae in patients with an open abdomen. TNP therapy was applied using the VAC device for 9 patients with a total of 17 fistulae. Three fistulae closed spontaneously with TNP therapy alone. For the remaining fistulae, TNP therapy controlled drainage and protected the wound until definitive surgery could be performed a median of 51 days later to resect the bowel and close the abdomen. No additional fistulae developed during TNP therapy. TNP therapy is an effective option for managing enteroatmospheric fistulae in an open abdomen.