Introduction Infected non-union of the tibia remains to be a great chal- lenge to orthopaedic surgeons. Due to its subcutaneous location, the tibia is vulnerable to be deprived of its soft tissue coverage with subsequent desiccation and infection of exposed bone [1]. Deep infection would ruin any recon- structive attempt unless properly debrided. Management of infected non-union of the tibia necessitates adequate debridement and reconstruction of the resultant bone and soft tissue defect [2]. Such complex reconstruction is preferably performed in a staged manner to avoid recur- rence of infection [3]. After debridement, the resultant dead space invites collection of hematoma and infected transudate. Elimination of this dead space, either by acute limb shortening or insertion of a spacer would prevent such collection [4, 5]. Several articles have described the results of debride- ment of bone infection and the use of antibiotic-cement spacer. However, these studies included heterogeneous anatomical and etiological group of patients. The aim of this prospective study was to evaluate the results of an integrated treatment protocol in a uniform group of patients with severely infected nonunion of the tibia. This protocol is based on staged debridement and elimination of the dead space in preparation for recon- struction of composite bone and soft tissue defect by dis- traction histogenesis using Ilizarov external fixator. With emphasis on the role of negative pressure wound therapy in the post-debridement phase. Patients and methods Twenty three adult patients aged 19 to 52 years (average 24 years) were treated in this prospective study in the period between January 2014 and June 2017. There were 4 female and 19 male patients. The study included patients with actively infected nonunion of the tibia whether fol- lowing operative fixation or open fractures in adults. All patients had previous debridement procedures ranged from two to four times. Ten patients (43.5%) had retained hardware, six cases (26.1%) infected open fracture and seven (30.4)% presented with infected nonunion. All procedures performed in this study were in accordance El-Rosasy, M, et al. Debridement Technique and Dead Space Management For Infected Non-Union of the Tibia. International Journal of Orthoplastic Surgery. 2019; 2(1), pp. 29–36. DOI: https://doi.org/10.29337/ijops.34 2 * Tanta University, Faculty of Medicine, EG † Chicago Lower Extremity Surgical Foundation, Chicago, US Corresponding author: Mahmoud El-Rosasy (elrosasym@yahoo.com) ORIGINAL RESEARCH Debridement Technique and Dead Space Management For Infected Non-Union of the Tibia Mahmoud El-Rosasy * , Ashraf Mahmoud * , Osama El-Gebaly * , Ahmed Lashin * and Edgardo Rodriguez-Collazo † Infected non-union of the tibia represents a major challenge to orthopaedic surgeons. Wide resection of infected tissues decreases the recurrence rate of infection in post-osteomyelitis reconstruction. Such radical debridement results in bone and soft tissue defects making the challenge more di fcult with creation of a dead space. Elimination of the dead space is a necessity using antibiotic-impregnated cement as a staged technique for further reconstruction of bone and soft tissue. The objective of this series is to assess the efcacy of our integrated protocol for management of infected non-union of the tibia. This prospective study included 23 patients with infected non-union of the tibia with medullary contamina- tion managed by staged debridement and insertion of antibiotic-impregnated cement spacer with later distraction histogenesis using Ilizarov frame for bone and soft tissue reconstruction. The mean age of the patients was 24 years (19 to 52). The mean size of the defect after debridement was 6 cm (range 4–10 cm). The average follow up period was 28 months (range 16–36 months). Successful reconstruction with no recurrence of infection was achieved in all cases (100%) without the need for bone or soft tissue grafts. External fxator index ranged from 35 to 60 days/cm (average 45 days/cm). The functional results were satisfactory in 20 cases (86.9%) and unsatisfactory in 3 cases (13.1%) due to residual leg length discrepancy, joint stifness, and persistent pain. The proposed staged protocol represents a valid option for successful bone and soft tissue reconstruction and elimination of the infection without the need of bone grafting nor soft tissue procedures. Keywords: tibia; infection; nonunion; debridement; cement spacer; Ilizarov