الفهرس 
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Abstract
This study was prospective cohort study that included 40 patients with open fracture tibia type IIIB that were admitted to Emergency and Traumatology Department of Assuit University Hospital in the period from April 2019 to April 2020Most of patient at middle age range from 18 to 60 years, with no comorbidity except 2 patients have DM and one patient hypertensive The controlled group consist of 20 patients (group A) treated by conventional dressing. The another cases collected in group B (20 patient) treated by Vacuum Assisted Closure Each patient in both groups managed by the same protocol, at first by ATLS, intra-operative debridement and temporary external fixator.Our intervention occur after primary debridement and external fixation of the open fracture include the novel form of treatment that uses sub atmospheric pressure (vacuum) to affect early on wound healing by cover only the raw area.his method employs negative pressure via a special closed wound dressing by intermittent or continuous application to the wound. This negative pressure leads to improved healing, drawing the wound edges together. Stabilization of the wound environment, accelerates wound healing by promoting the formation of granulation tissue, decrease in wound edema and removal of wound exudate.The primary objective of our study is monitoring of time needed for soft tissue coverage in both groups. At the end of study we found that: Mean time for soft tissue coverage was significantly lower among the VAC group versus to the other group (12.22 ± 2.90 vs. 23.56 ± 8.68 (days). Range of time to coverage was between 4 and 16 day in case of VAC group while it was between 4 and 40 day in the other group. Frequency of intraoperative debridement was significantly lower among the VAC group versus to the other group. Range of frequency of intraoperative debridement was between 0 and 2 times in case of VAC group while it was between 1 to 4 times in the other group.