Background: Negative pressure wound therapy (NPWT) is an integral technique in treating severe wounds and preparing the wound bed for skin grafting in orthopedic surgery. The AquaVac system from the Philippines uses an aquarium pump in reverse and is available in the local setting. The benefits of NPWT may outweigh its minor complications, and several local skin problems have been observed especially with prolonged use. One of the remarkable complications found is a pressure injury to the integument caused by the suction tube. However, there have been limited studies as to the incidence of this specific local periwound skin complication. Methods: A retrospective case series was performed by going over the resident logbooks of the Department of Orthopedics and Traumatology in *Hospital Anonymized* from 1^st January 2013 to 31^st December 2022. Slides of cases that underwent NPWT were picked out and graded by three independent observers for the presence of pressure injury and other periwound skin complications on the wound bed and surrounding skin. The number of cases presenting with the complications was then tallied. Inter-rater reliability (Krippendorff) α-coefficient was computed using Statistical Package for the Social Sciences (SPSS) version 25. Results: Among 788 consecutive cases with retrievable documentation, 355 cases (45.10%) were found to have NPWT pressure-related injuries. The lower extremity comprised 656 (83.24%) of the series, while 118 (14.97) were from the upper extremity and 13 (1.65%) were applied on the sacrum. Among the 355 cases found to have a pressure-related injury, 290, (81.7%) were at-risk, for stage I ulceration and 65, (18.3%) had dermal injury equivalent to stage II ulceration. There were no patients with pressure injuries from NPWT application reaching the level of muscle or bone. Inter-rater reliability for pressure injury rating was in perfect agreement. Reliability for pressure injury grading showed an α-coefficient of 0.89. Conclusion: Stage II lesions were the deepest ulcers observed in our series. Awareness of this poorly reported finding can lead to a more defined protocol for the utilization of NPWT. We propose lining the suction tube with foam dressing to help alleviate this complication.