Background: Pressure damage in paraplegic patients is difficult to manage due to their limited mobility. Topical Negative Pressure Therapy (TNPT) has successfully been used for different types of wounds, including cavity wounds, leg ulceration and pressure ulcers (PU). The introduction of TNPT with instillation (TNPTi) has increased the categories of wounds that can be treated. Aim: To describe the wound management of an unstageable pressure damage with underlying osteomyelitis. Methods: Observation of the care provided to a patient presenting with an unstageable pressure damage on admission. On further investigation osteomyelitis was found. Results: Following 3 months of the application of TNPTi, the wound size had reduced significantly, making it suitable for flap surgery. The benefits of undertaking flap surgery after an overall short time thanks to this treatment includes also the psychological and social aspects of the patient’s life. This also reflected in a positive impact on the patient’s wellbeing and reduced length of hospitalisation. Conclusions: The use of TNPTi positively affected the healing process of an unstageable PU presenting with osteomyelitis. Further studies are needed to validate the effectiveness this treatment regimen.