Objective: To evaluate the clinical effect of vacuum sealing drainage (VSD) combined with external fixator on the treatment of Gustilo type III fractures of tibia and fibula. Methods: The treatment and follow-up of 49 patients with Gustilo type III fractures were retrospectively analyzed, according to the treatment method, 26 cases were divided into study group and control group 23 cases, the study group was treated with VSD + external fixator, and the control group was treated with external fixation and traditional dressing change. Results: In the study group, the wound healing time was (68.5±22.4) d, fracture healing time was (5.4±1.7) months, both are significantly lower than that in the control group with wound healing time (115.8±47.3) d, and fracture healing time (7.8±2.3) months, the differences was statistically significant (P<0.05). The wound healing and bacterial clearance rate in the study group in the postoperative 1, 2 and 3 months were higher than those of control group, but only in postoperative 2 months the difference between the two groups has statistical significance (P<0.05). The excellent rate of ankle joint in the study group was 88.46%, higher than that in the control group (69.57%), but the difference between the two groups was not statistically significant (P>0.05). In the study group, the rate of excellent and good rate was 92.31%, which was significantly higher than that of the control group (69.57%), and the difference between the two groups was statistically significant (P<0.05). Conclusion: VSD combined with external fixation in the treatment of tibiofibular fracture of Gustilo type Ⅲ can shorten the wound healing time, and for patients with recovery of limb function also has a role in promoting.