Abstract: Objective To observe the effect of flap grafting combined with Ilizarov external fixation in treatment of Gustilo Ⅲ tibiofibular fracture. Methods Totally 45 patients with Gustilo Ⅲ tibiofibular fracture were treated with emergency debridement and limited incision to repair the integrity of tibia and fibula, and the effective fixation of fracture was achieved by Ilizarov external fixator. According to the degree, location and size of the skin and soft tissue defect, the skin flaps were designed for stage Ⅰ or Ⅱ closed wound repair. Results Among 45 patients, there were 20 cases(44.45%)with stage Ⅰ wound healing and 22 cases(48.89%)with stage Ⅱ wound healing. Among 3 cases without stage Ⅰ or Ⅱ healing, there were 1 case with superficial flap infection, 1 case with small area of bone exposure, and 1 case with all flaps necrosis, and the wounds were all healed after symptomatic treatment. The fracture healing rate of 45 cases was 100.00%, and the average clinical healing time was 11 months. Conclusion Flap grafting combined with Ilizarov external fixation is an effective and feasible method for repair of Gustilo Ⅲ tibiofibular fractures.