Objective To explore the timing of wound closure and the choice of methods in Gustilo Ⅲtype tibiofibula open fractures after emergency debridement.Methods 42 patients with Gustilo Ⅲ type tibiofibula open fractures from January 2014 to January 2015 were selected as the observation group.All patients were performed emergency fracture fixation after debridement and wound secretion culture immediately after debridement, if the training result was positive,the debridement,again until the training results for negative when square in 48 hours after closing a wound.Selected 38 patients with GustiloⅢtype tibiofibula open fractures,the prompt debridement 38 cases were fracture fixed routine treatment after closing the wound,they were set as the control group.Compared two groups of patients with wound infection and fracture healing.Results The fractures wound infection rate of the observation group was 4.76%,which was significantly lower than 15.79% of the control group,the difference was statistically significant(χ2 =10.739,P=0.000).The wound healing time and fracture healing time of the observation group were significantly better than those of the control group,there were statistically significant differences( t=9.684,7.324,all P<0.05).Conclusion GustiloⅢtype emergency open tibiofibula fracture after debridement of the wound closure time should according to the results of wound secretion culture,cultivate the results can be achieved when the negative for wound closure,according to the degree of injury of soft tissue,to choose the right means of wound closure.

Objective:To investigate the effect of ship-shaped expanded polytetrafluoroethylene (e-PTFE) nasal prosthesis in rhinoplasty.Methods:From February 2016 to June 2021, 86 patients, including 9 males and 77 females, aged 18-47 (24±5) years old, were admitted to Chengdu High-tech Zone Xinyuerong Medical Aesthetic Clinic for cosmetic treatment of rhinoplasty. All patients underwent rhinoplasty with the application of ship-shaped e-PTFE and autologous cartilage. The postoperative complications, glabellar fullness, inverted brow triangle, nasal polygon aesthetic shape and patient satisfaction were evaluated. These data were measured and analyzed, including the nasal length, nasal tip height, nasal frontal angle and nasal facial angle before and after the operation.Results:In 86 patients, the incision healed in one stage after surgery, and 8 cases had nasal vestibular scar hyperplasia. All patients were followed up for 1-5 years: 84 cases obtained satisfactory nasal morphology, and 2 cases recovered naturally after adjusting and lowering the prosthesis height half a year after surgery because the interbrow area was too full. 74 patients (86%) were very satisfied, 10 cases (11.6%) were satisfied. The nasal length was (4.07±0.20) cm, the nasal tip height was (2.66±0.36) cm, the nasal frontal angle was (106.42±8.04)°, and the nasal face angle was (15.90±0.85)°before operation. The nasal length was (4.23±0.20) cm, the nasal tip height was (2.59±0.26) cm, the naso-frontal angle was (113.69±6.34)°, and the naso-facial angle was (21.57±0.78)° at eighteen months after operation. There were statistically significant differences in nasal length, naso-frontal angle and naso-facial angle ( t=-5.51, -5.96, -52.31, P<0.01), but no statistically significant differences in nasal tip height ( t=1.47, P=0.146). Conclusions:The ship-shaped e-PTFE can be shaped to reflect the aesthetic of the nose dorsum, which is similar to the anatomical structure of the nose dorsum, increase the stability and authenticity of the prosthesis, and is worthy of clinical application.