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Background: Highgradeopenfracturetibiaiscommoninroadtrafficaccidentanditassociationwithmassivesofttissueinjuriesposesagreat challenge,andrequiringcomplexmultilevelandmultidisciplinaryapproachprocedures.Despitetheimprovementintechnology andsurgicaltechniques,ratesofinfectionandnonunionarestilltroublesome.Themainstayoftreatmentinvolvestimelyinitial debridementandirrigationofthewoundandprimaryfixationwithantibioticcementcoatednail.Secondlooksurgeryif indicatedwithin72hoursisdone.Theexposedboneiscoveredasmuchaspossiblewiththeremainingviabletissuesand whateverisexposedfromtheinitialinjury,isdressedwithnegativepressurevacuumdressing.Thisisselectedasameansof temporarysofttissuecoveragebeforeinstitutionofthedefinitivetissuecoverage.Thisisanidealartificialcover.Itprevents desiccationofexposedvitalstructures,promotevascularingrowth,removeedemafromthewoundbed,limitbacterial proliferation,minimizepain,andpreventrepetitivetraumatothewoundbed,Itisagoodphysicalbarriertopreventsecondary bacterialcontaminationfromtheenvironment. Methods: Thisisaretrospectivestudiesof3patientswithaminimumof1yearfollowup.Informationonthetimefrominjurytodefinitive woundcoverage,typeoffixation,typeofcoverage,anddemographicsweredocumented Results: Patientswhounderwentnegativepressurewoundtherapieswithin7daysfromtraumahadasignificantlygoodgranulation tissuewithin2to4weeksbeforedefinitivesofttissuecoverage.Softtissuecoverwasonlysplitskingraftsupplementedwith vacuumdressing. Conclusion: Routineuseofnegativepressurewoundtherapyasanadjunctmodalityissafeandisagoodalternativeforprimarydressing overopenwoundsforGustillo3Btibiafractures.Utilizingthismethodnotonlyhelpspatienttorecoverfasterbutalsoallows salvageofthelimb,shortenhospitalstayandcostsavingaswell.