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Aim: An acid-based debriding gel (TDA*) works through a strong hygroscopic action. When applied onto biofilm and/or necrosis, rapid desiccation and denaturation of microorganisms and tissues occurs. Typically, quick sloughing follows. In a previous study, TDA was shown to assist in the rapid development of granulation tissue, a necessary step in healing by secondary intention. Negative pressure wound therapy (NPWT) also supports the development of granulation tissue. The aim of our study was to assess the combination of TDA and NPWT on efficacy of the development of granulation tissue. Method: TDA was applied for 60 seconds and rinsed off, after which NPWT (at -125 mmHg) was applied for up to one week. The percentage of granulation was assessed on a 3-daily basis. Results / Discussion: 12 ulcers (in 12 patients) of the lower leg participated. Ulcers were venous (N=5), arterial (N=2), and mixed venous/arterial (N=1). One lesion was post-trauma (etiology unknown: N=3). Average size was 308 cm2 and average wound-age was 13 months. Each patient had at least one serious comorbidity. Average time to complete granulation was 13,2 days (range: 7-21). There were no side effects to NPWT or TDA treatment. Conclusion: In this study, combining TDA therapy with NPWT was shown to assist in the rapid development of granulation tissue. This indicates that healing by secondary intention is supported by this treatment routine. The use of TDA was also shown to be cost-effective in a separate study. * Debrichem, DEBx, the Netherlands [ABSTRACT FROM AUTHOR]