The timing of wound closure in open fractures has long been an ambiguous area in the treatment of open fractures. Although striving for one-stage window healing is an important principle in open fractures, there are several situations that do not allow this requirement to be met, and early forced closure of more contaminated wounds can be counterproductive. Most clinical practitioners advocate the use of one-stage closure of open fractures of type I and type II mildness, which is also known as the principle of open-to-closed treatment. Early closure of the wound can effectively prevent wound infection. However, for heavy type II and type III open fractures with large trauma, severe contamination, and unclear boundaries of early soft tissue necrosis, it is often difficult to completely remove all necrotic tissues in one debridement, so the method of delayed primary closure (DPC) is commonly used. The delayed primary closure approach is used in an open fracture treatment protocol for 422 patients. The main idea was to provide routine irrigation, debridement, stable external fixation, and open fracture routine care to patients with fractures after consultation, withholding surgical treatment and instead repeatedly performing microbiological cultures and irrigation in the wounds while applying antibiotics. Until reliable microbiological specimens were obtained, the patient was then treated surgically and satisfactory results were received. The coverage of open wounds is also an area of current international concern. Exposed bone surfaces and tendons can be covered with nearby tissues (e.g. fascia, bone flesh, etc.). The wound is re-rinsed with hydrogen peroxide and saline, and specimens are taken for bacterial culture and drug sensitivity testing as a basis for antibiotic adjustment. The wound was dressed with petroleum jelly gauze and cotton pad, and the wound was changed once or twice a day after surgery according to the wound exudation. Postoperative antibiotics were administered intravenously to actively fight infection and enhance nutrition to promote wound healing. However, delayed wound closure increases the chance of bacterial inoculation, and the possibility of recontamination of the wound by airborne dust and microorganisms in the ward due to lax aseptic practice during dressing changes and the siphoning effect of the dressing wet with secretions. In earlier times, the treatment of open fracture infection was based on the use of antibiotics, debridement, fixation, and soft tissue coverage. The Vacuum-Assisted Closure (VAC) system is a new wound treatment technique in which a drainage tube connected to a special vacuum pump is placed on the wound surface and wrapped with gauze or polyurethane sponge, followed by a transparent film to close the wound surface, and a negative pressure environment is created by the negative pressure pump to treat the wound surface. The technique was investigated during the entire Iraq war; 20,000 soldiers were injured and used. The majority of these soldiers had soft tissue defects or open fractures due to combat injuries. Currently, this technique is theoretically the optimal choice for a variety of biologic patches that have emerged. Although few data are available to fully reflect the rationale and drawbacks of this approach, Stannard randomized 62 patients with severe open fractures to negative pressure suction treatment who were treated with sterile saline dressings. As a result, 5.4% of the patients developed wound infection, a finding that was statistically significant when compared to a control group with a prevalence of 28%. So, is the use of vacuum-assisted closure therapy system effective in delaying wound closure compared to soft tissue coverage? A study was conducted by Timothy Bhattacharyya et al. The material used was a nonadherent sponge, and 38 patients were treated. The conclusion was that within seven days, the infection rate was 12.5%. However, once the seven days were exceeded, the infection rate increased by a value of 57%. Therefore, the current clinical study shows that the application of the negative pressure suction technique does not delay wound closure in the long term. However, Vac technology has its own drawbacks, as it is too expensive and requires a manufacturer with technological capabilities to produce it, as well as a suction system that needs to be constantly powered during its operation. In addition, the Vac requires a trained nursing team to get it up and running. Of particular importance is the fact that this method has been reported to cause MRSA, which is currently a serious problem for VACs. Antibiotic Bead Pouch is another method. Antibiotic Bead Pouch was first proposed and used in clinical treatment by Henry et al. Scholars made a clinical study of this, they took the method of making each cement bead pouch with 2 g vancomycin and 1 g tobramycin inside. The size of the beads was similar to that of a pea. Once the beads were formed, they were placed inside the contaminated wound (after debridement and irrigation). and covered with gauze. This way the drug will be released slowly into the wound. The injured limb should also be immobilized to allow the soft tissue’s to repair and to reduce edema. Cement beads are simple to make and can effectively delay wound closure for 3-5 days. It is also relatively inexpensive, does not require wound suction, does not require a lot of human care mechanisms, does not require a lot of device maintenance, does not have the consumption of equipment, and its cost is only a fraction of VCD. This low-cost and quick method is conducive to large-scale applications, such as the U.S. Army in the battlefield of Afghanistan, had a small-scale trial, and achieved good results. At the same time, it can take care of the more economically disadvantaged groups. It can also effectively reduce the amount of antibiotics. Gustilo II degree heavy and III degree premature closed wounds, although a certain degree of protection from re-contamination of the wound during treatment, but at the same time, also the information within the wound and the doctor completely isolated. At this point, the physician does not have access to accurate information about anything that is happening inside the wound. In this case, although analysis can be performed based on the drainage, it is not intuitive enough. It is impossible to find out deeper and more accurate information about the infection, such as: whether the cultured microorganism is from external contamination or internal blood transmission; the depth and extent of contamination in the wound at this time; and the existence of soft tissue dead space, the drainage may not be able to fully reflect the foci of infection. In the past, most of the clinicians’ treatment methods were to apply high-dose antibiotics to avoid infection, which was very effective in reducing the infection rate, but the problem of antibiotic abuse ensued. Blast wounds allow for ready access to wound infection information, targeted medication, and reduced side effects of medications. But there must be a prerequisite that the process of flushing the wound and taking specimens together during the open period must be scientific in order to prevent the occurrence of wound reinfection, which seems to be not difficult to do under the current medical conditions. Therefore, the author believes that the above-mentioned postponed closure approach is scientific and feasible. The treatment of open fractures, from patient handling, debridement, choice of fracture fixation, problems during wound closure, and post-injury antibiotic application and postoperative care, can be a challenge even for the most experienced orthopedic surgeons. The discussion of various treatment options should not rely on authoritative literature. Rather, it should be frequently summarized and shared in order to further rationalize surgical protocols. In particular, attention should be paid to the development and application of new materials, such as the wound dressing chosen for wound closure. It is believed that with the development of technology and the improvement of medical skills, the mortality and disability rate of open fractures will be greatly reduced.