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Abstract Objective To investigate the efficacy of zipper negative pressure close drainage combined with external fixator in the treatment of Gustilo type Ⅲ tibiofibular fractures.Methods From April 2014 to May 2017，20 cases of Gustilo type Ⅲopen fracture of tibia and fibula were treated with zipper type open door negative pressure drainage combined with external fixation.There were 15 males and 5 feimales，aged 17～58 years with an average of 35.6 years old.According to Gustilo typing，there were 5 cases of type Ⅲ A，10 cases of type Ⅲ B，5 cases of type Ⅲ C.All patients underwent emergency debriderment.Close drainage with zipper was used to protect the wound surface，.The wound was cosed by direct suture、 free skin graft or skin flap.Results 20 patients were followed up for 12 to 30 months(20.95±1.16)months.All the patients were treated with zipper open door negative pressure drainage and the wound was closed after 4～30 days late.2 patients suffered from wound infection and tissue necrosis.After debridement and zipper open door negative pressure drainage，the wound was repaired by free skin grafting and transfer flap.1 cases of nail infection were cured by dressing and antibiotic therapy.20 cases of fracture were healed and the healing time was 6～16 months (12.60±0.65)months，2 cases had delayed union of bone，2cases had nonunion，removal of the external fixator and bone dreat plate screw fixation，and finally healed.At the last follow-up，the function of knee and ankle was evaluated according to the Johner-Wruhs score standard.Excellent in 12 cases，good in 7 cases and poor in 1 cases，excellent rate 95 percent.Conclusion Open the zipper type vacunm sealing drainage combined with external fixation in the treatment of Gustilo type Ⅲ tibiofibular fractures can effectively prevent wound infection.It，is a safe and effective method of treatment.
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