**1. Introduction**

The Lautenbach procedure involves debridement, intramedullary reaming and the insertion of double-lumen tubes to establish both a local antibiotic delivery system and cavity analysis for volume and culture (**Figure 1**). The end-point of treatment is when the irrigate produces three consecutive clear cultures with improvement in the blood indices and obliteration of the cavity volume [1–3].

In theater, the patient's affected limb is debrided, and sequestra are removed and cleaned. After that holes will be made (Reaming) on the bone. These holes will be enough to insert an irrigation tube, which is a double-lumen tube that means the tube has a smaller tube inside. There is one big tube (perforated) which drains the irrigation fluid from the patient and an intra-catheter inside that administers an antibiotic to the bone and its bone marrow. These tubes will stay with the patient from two weeks upwards or until the patient is cleared of infection.

#### **LAUTENBACH INSTILLATION SYSTEM**

50ml saline bag: add 80mg Gentamicin to each bag = "irrigation fluid" \*

When emptying or compressing the Bellows, ensure the **Red clip** is closed and open the **White clip** to prevent backflow up into the patient again

#### **Figure 1.**

*Diagram of the Lautenbach irrigation system. Author: Charlotte Maxeke, Ward 369, Johannesburg Academic Hospital, South Africa. Adapted from original drawing, used with permission.*
