Objective To evaluate the long-term func ti onal outcome of the Gustilo-typeⅢB andⅢC open fractures of the tibia treate d with limb-salvage.Methods Twenty-onepatients,including16cases of Gustil o-tapeⅢB and5cases of ⅢC open fractures of the tibia,were repaired by30f ree vascularized tis-sue flap transfer from1990to1999.The soft tissue and bone defect of 13cases Gustilo-typeⅢB open frac-tures of the tibia wer e repaired simultaneously with osseous-cutaneous flap or musculo-cutaneous-o sseous flap transplantation,the soft tissue defect in3cases of open fractures of the tibia were covered with cutaneous flap or musculo-cu taneous flap at first setting,and the tibia defect or non-union were repaired with vascu lari zed osseous flap at the second.The posterior tibia vessels were reconstructed in all of 5cases of Gustilo-typeⅢC group,in3cases of which posterior tib ial nerve were repaired simultaneously,and emergency cutaneous flap or musculo-cutaneous flap transfer were performed in2cases,delayed vascularized flap tr ansplantation were performed in another3cases.The salvageable limb function w as assessed according to the punos sev en-scale score criteria which includin g freedom of pain,activities of daily life,range of motion,residual deform ity,ra-diographic changes,muscle strength and sensation.Results Twnety-twov ascularized tissue flaps were trans-ferred at first setting in21patients,1 9vascularized tissue flap survived,and other3vascularized tis sue flap failed .The survival rate was86.4%.The average duration from the injury to the f irst vascu larized tis sue flap transplatation was84days.The soft tissue defe ct was completely re paired after the second setting and the fracture or defect was united finally;the average number of procedure for the Gustilo-typeⅢB was4and10for the Gustilo-typeⅢC tibial fractures with an average period fr om injury to bony union of 210and640days in typeⅢB and typeⅢC respective ly.After an average58months of follow-up,ranging from17to129months, 10case obtained excellent and good re sults(62.5%),4cases fair(25 .0%),2cases poor (12.5%)in Gustilo-typeⅢB tibia open fracture.Th ere were no one with excellent,good and fair results,5cases poor (100%) in Gustilo-typeⅢC.Conclusion Theamputation below the knee should be consid-e red for the Gustilo-typeⅢC open fractures of the tibia,especially along wit h the severe injury of the ankle or the dis ruption of poste rior tibial ner ve or the obvious limb shortening.The Gustilo-typeⅢB open frac-tures of t he tibia should deserve reconstruction with the technique of microsurgery,and the functional recov-ery of the salvageable limb was satisfactory.

Objective To explore the promoting effects of bio-polymer composite film as a micro-skin auto-graft covering on wound healing. Methods The full thickness skin defect models were made on both sides of 30 experimental rabbits. Then, the rabbits were randomly divided into experimental group and control group. In the for-mer group, the side was covered with chitosan/glucomannan composite membrane and in the latter, the side cov-ered with acelluar porcine skin after micro-skin autograft. We obtained wound tissues at week 1 , 2, 3, 4 and 5 af-ter operation. The conditions of wound healing were observed, the rate of wound healing was calculated, HE stain-ing was made, and PCNA and CD31 were detected by immunohistochemistry. Results (1) During 2~4 weeks af-ter operation, the rate of wound healing in the experimental group was significantly higher than that of the control wound (P<0.01). (2) The amount of neutrophil in experimental group was less than that of the control after oper-ation. (3) During 1 ~ 2 weeks after operation, the expression of PCNA in the experimental group was higher than that of the control group (P < 0.01), but lower than the control wounds during 1 ~ 2 weeks after operation (P <0.01). (4) During 1 ~ 5 weeks after operation, the expression of CD31 in the experimental group was higher than that of the control group (P < 0.01). Conclusion Chitosan/glucan-mannan composite membrane as a micro-skin autograft covering may promote wound healing.