For chronic venous disease, varicose veins, and venous ulcers, the correct application of bandage compression can be just as effective a treatment.
Bandage compression systems often use one to four layers of elastic or non-elastic bandages to apply compression. This is not a treatment that can be performed by just anyone, but usually requires a trained professional to perform it safely.
Let’s start by looking at a few different types of bandages.
Non-stretch bandages and similar articles
Non-elastic bandages can provide higher compression during leg muscle contractions (e.g., walking), but the level of compression decreases over time.
Non-elastic bandages have little or no stretch and cannot accommodate volume changes in the leg if edema increases due to prolonged standing or if swelling decreases due to elevation of the lower extremity.
Elastic bandages and similar articles
Elastic bandages are classified as high-elastic bandages, low-elastic bandages or specialized multi-layer bandage systems. High-stretch bandages are stretchy but do not provide sufficient compression; they are usually used for immobilization and less often for the treatment of venous disease or venous ulcers alone; multi-layer bandage systems are usually 2-4 layers, with at least one absorbent layer of wool or cotton fabric (usually close to the skin) and an elastic bandage layer.
Tips for bandage compression
- Compression bandages should be wrapped around the upper calf starting at the foot and gradually decreasing the pressure from distal to proximal.
- Starting at the distal end of the metatarsophalangeal joint, the heel should also be wrapped in, and at the knee the head of the fibula should be covered.
- bandages should be applied by wrapping the foot and leg on all sides, and padding or padding should be used in depressed locations to balance the pressure
- the dorsalis pedis artery and common peroneal nerve travel superficially under the skin and care should be taken to avoid injury when bandages are applied
- The ankle should be held in a neutral position and at a right angle before the bandage is applied; the knee should be properly bent to prevent popliteal congestion during hyperextension.
- The bandage should be rolled close to the leg to avoid pulling it far apart, as this tends to create folds in the bandage.
- There are usually multiple methods of stacking bandages that allow for different compressions to be applied. For example, the spiral method compared to the Putter method, with the former providing a somewhat better grip
Proper implementation of the bandage will provide the patient with the comfort of a firm support. Compression bandages can be effective when combined with active exercise. Therefore, if the patient wears the bandage and then exercises, the treatment success rate is higher.
Use of multi-layer bandages and similar articles
Layer 1 – padding layer
The padding layer is mostly cotton padding or wool padding without ductility, which mainly plays the role of padding, cushioning, protecting skin and tissues, and absorbing exudate. For some people with little skin fat or fragile skin, soft padding should be used to protect the edges of the bandage, bony prominence and other locations prone to skin necrosis, such as the tibial ridge, metatarsal, dorsum of the foot, inner ankle, outer ankle and Achilles tendon area. In people with thin extremities, the tibial ridge is susceptible to pressure ischemia, some of which is not detected until after the bandage is removed. The treatment is simple: a wool pad is placed in that location. For people with bunion deformities, additional padding should also be used in the metatarsal region to prevent compression.
Layer 2 – Crepe layer.
A crepe bandage is a thin layer of bandage used to secure the cotton or wool pad inside so that the surface fits smoothly. This layer has no or little compression effect, mainly for the next layer of bandages for preparation.
Layer 3 – Elastic bandage layer
This layer is the first of two elastic bandage layers and provides approximately 17 mmHg of compression when the bandage is extended 50% and overlapped 50% and wrapped in a figure of 8. For “champagne-shaped” lower limbs with ankle liposclerosis, the 8-shape can be extended to increase the fit. If the patient has significant leg edema and requires more compression, you can: (1) increase the bandage extension by >50%; (2) overlap by >50%; and (3) add more layers of elastic bandage. Conversely, if the patient’s extremities are shriveled, the pressure can be reduced appropriately. The advantage of the elastic bandage is that the pressure can be adjusted according to the patient’s condition, but care should be taken not to reduce the pressure to an ineffective level.
Layer 4 – Cohesive bandages and similar articles
The outermost adhesive bandage provides higher pressure, up to 23 mmHg, so be careful not to overstretch it. Some doctors mistakenly believe that this layer only serves as a fixation. This layer of bandage should cover more than the upper gastrocnemius tautness to avoid slippage. Care should be taken not to compress the nerve too tightly in the position of the common peroneal nerve. This layer usually contains latex cost and to avoid latex allergy, contact with the skin should be avoided or a latex-free adhesive bandage should be used. If the pressure is not sufficient, two layers of adhesive bandage can be used, which can provide up to 40 mmHg of pressure.
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