Negative pressure wound therapy provides a nonsurgical treatment option for many types of complex wounds. This therapy utilizes the vacuum-assisted closure device, which decreases air pressure, removes fluid that accumulates within the wound, and aids to facilitate changes that promote healing. Despite the increased use of negative pressure wound therapy in the head and neck region, there is substantially less data available on the management of transoral vacuum-assisted wound closure. Herein, we present a case of a novel approach for the creation and use of a transoral wound vac for a patient with a refractory orocutaneous wound in the setting of multiple previous free flaps and surgeries. A watertight seal was able to be maintained and the patient was compliant with treatment, resulting in successful management of the wound. We promote the consideration of this novel technique’s use for similar difficult-to-treat oral wounds. © 2023 Oxford University Press. All rights reserved.