This article presents a step-by-step demonstration of vacuum-assisted closure (VAC) change for a complex right hip wound following Girdlestone procedure in a paraplegic patient with MSSA bacteremia. The case emphasizes preoperative review to ensure complete sponge removal, meticulous debridement, and careful dressing application. A single VAC sponge with a tailored extension was used to optimize fit and simplify future changes. The wound was sealed using dry plastic film and bridged to prevent pressure injury. The procedure underscores the value of performing VAC changes in the operating room for complex and deep wounds with chronic infection.