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Wound dressings and bandages

Introduction

The history of the development and use of dressings has seen an evolution through many centuries from inert and passive products such as gauze, lint and fibre products to a comprehensive range of modern moist wound dressings.

The range of dressings increases every year and is often a source of confusion when attempting to differentiate between both similar and different dressings. The simplest way of classifying dressings is by their functionality.

Wound products can be divided into two broad groups:

  • Passive products
  • Interactive products

Within these two groups, the passive dressings can be sub-classified into absorbing and non-absorbing dressings; whereas, the interactive dressings can be sub-classified as absorbing, non- absorbing and moisture donating. The interactive group has six different dressing types.

Turner has defined the following as the properties of the ideal wound dressing:

  • Removes excessive exudate from the wound without allowing the wound to dry out thereby maintaining a moist environment
  • Allows gaseous exchange so that oxygen, water vapour and CO2 may pass in and out of the dressing
  • Is thermally insulating so as to maintain the wound core temperature at approximately 37 degrees centigrade
  • Is impermeable to micro-organisms in order to minimise contamination of the wound from outside the wound itself
  • Is free from either particulate or toxic contamination
  • Is non-traumatic and does not adhere to the wound, so that at dressing change it will not damage granulating tissue.

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Passive dressings

For many years the products used were of the 'passive' or the 'plug and conceal' concept and included gauze, lint, non-stick dressings, and tulle dressings.  Passive dressings fulfil very few of the properties of an ideal dressing and have very limited (if any) use as a primary dressing; however, some are useful as secondary dressings.

It is clear there are a number of negative aspects in the use of gauze:

  • Being a fibrous material, tends to shed very readily and will contaminate the wound.
  • It is highly absorbent and as a primary dressing will tend to dry the surface of the wound rapidly.
  • It is permeable to bacteria and moist gauze tends to be an environment ideal for the growth of bacteria. This may increase the risk of penetration and contamination of the wound.
  • Is also adherent and will further traumatise the wound on removal, risking damage to granulating tissue and causing pain.

In addition to gauze, lint and cotton dressings, other simple modified absorbent pads covered with a perforated plastic film to prevent adhering to a wound (such products include Melolin™, Cutilin™ and Telfa®) are used both as primary and secondary dressings.  They are used in minor and low exudating wounds. 

A modern inert absorbent dressing

Exudry™ Zetuvit™ and Mesorb® are examples of products with a highly absorbent pad and a non-stick, non-shear surface. They can be used as a secondary dressing over moderate to highly exudating wounds and over hydrocolloid paste, cadexomer iodine, alginate and other primary dressings.

The non-absorbent tulle passive dressings

Non-absorbent passive dressings such as paraffin gauze (tulle) dressings, are among the earliest modern dressings. Many variations have been developed over the years by changing the loading of paraffin in the base.  In general, these dressings produce a waterproof paraffin cover over the wound which may lead to maceration in that water vapour and exudation may not pass through and so become trapped within the wound. These products:

  • are permeable to bacteria
  • are known to adhere to the wound causing trauma on removal
  • require a secondary dressing.

Their use is limited to simple, clean, superficial wounds and minor burns. They are also used as a primary dressing over skin grafts. There are modern alternative dressings composed of synthetic fibres tightly meshed and impregnated with materials that allow moisture to pass through and thus minimise any maceration of the wound and tissues. Examples include Adaptic™, Cuticerin™ and Atrauman®.  For patients with fragile skin, Mepitlel™ and Melitel One™ are excellent examples of non-fibre tulle coated with a non-stick Silicone coating.

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Interactive dressings

Interactive dressings help to control the micro-environment by combining with the exudate to form either a hydrophilic gel; or by means of semipermeable membranes, controlling the flow of exudate from the wound into the dressing. They may also stimulate activity in the healing cascade and speed up the healing process.

There are six classes of interactive dressings which are classified according to their functionality.

Non-absorbing dressings

Film dressings (for wounds with no to low exudate)

Film dressings consist of a thin, poly-urethane membrane coated with a layer of acrylic adhesive and:

  • are waterproof
  • are gas/vapour permeable
  • are flexible
  • protect from shear, friction, chemicals and microbes
  • are transparent
  • spread tension forces.

They are particularly useful in superficial, clean wounds and in the prevention of breakdown and pre-ulcers in pressure injuries. They are also used as a post-operative dressing over sutures and to reduce sub-tissue tension over a closed sutured wound after removal of the sutures or clips. Film dressings should not be used for infected wounds or fragile skin.

Brand Type
Film dressings
OpsiteTM

Plain film, Island Film
Flexigrid
Flexi Fix {continuous rolls}
IV 3000 {high MVTR*}
Post-op {island dressing}

TegadermTM

Plain film
HP* {high MVTR} with absorbent pad
Island dressing

BiofilmTM Plain film

Polyskin™ II
Aqua Protect®

Hydrofilm®

Plain film
MR* {high MVTR}
Plain film
Island Film
Plain film

Mepitel Film Silicone coated film

*MVTR = Moisture Vapour Transmission Rate
i.e. the level of passage of water vapour or exudate through the surface of the dressing.
*HP = Holding Power
*MR = Moisture Responsive

Absorbent dressings

Hydrocolloid dressings (for wounds with low to moderate exudate)

Hydrocolloids are a combination of polymers held in a fine suspension, and often contain polysaccharides, proteins and adhesives. When placed on a wound, the polymers combine with the exudate and form a soft, moist gel-like mass. They also encourage autolysis to aid in the removal of slough from a wound. Hydrocolloids:

  • are flexible and waterproof
  • provide a physical barrier
  • form a gel with exudate
  • aid in debriding
  • need no secondary dressing
  • are available in a thin form (transparent).

The early forms of hydrocolloids are occlusive, so as to make them impermeable to gases and water vapour. They do, however, act as a barrier to external bacteria and are waterproof enabling the patient to shower. The thin, transparent hydrocolloids have a polyurethane film backing and are non-occlusive, thereby allowing the passage of water vapour and gases.

Hydrocolloids should be applied over the wound with at least 3-4 cm extra product greater than the size of the wound. The skin should be dry and free from creams, ointments or oil to ensure good adhesion. The dressing should be placed 1/3 above the wound and 2/3 below the wound, as this will prolong the wear time of the dressing.  The dressing can remain in place for up to 7 days with removal dependent on the level of exudate and when ‘strikethrough’ has occurred (i.e. the exudate has migrated to the edge of the dressing).

Hydrocolloid products are used in low to moderately exudating wounds - including ulcers, donor sites (after haemostasis) and granulating wounds. They may also be used in conjunction with a paste or powder form. The paste or powder is used in a deeper ulcer or cavity. These convert to the same hydrophilic gel and are covered with the normal hydrocolloid wafer contraindicated in diabetic wounds.

Brand Type
Hydrocolloid dressings

Comfeel Ulcer Dressing™

Comfeel Powder™

Comfeel Plus Transparent™

Multiple Sizes

Single pack

Pack Multiple Sizes

DuoDerm CGF®

DuoDerm Border®

DuoDerm ExtraThin®

DuoDerm Paste®

Multiple Sizes

Multiple Shapes and Sizes

Multiple Shapes and Sizes

Tube

Replicare™ Multiple Sizes
Ultec™ Multiple Shapes and Sizes

Hydrocoll®

Hydrocoll Thin®

Multiple Sizes

Multiple Sizes

Tegaderm Hydrocolloid™

Tegaderm Hydrocolloid Thin™

Multiple Shapes and Sizes

Multiple Shapes and Sizes

Foam dressings (for wounds with medium to high exudate)

Foam dressings are soft, open-celled hydrophobic/hydrophilic non-adherent dressings that may be single or multiple layered and meet many of the properties of an ideal dressing.

Foam dressings:

  • allow the passage of exudate through the non-adherent surface to be absorbed in the main body of the product
  • are absorbent
  • maintain a moist environment
  • are thermally insulating
  • are cushioning
  • are non-adherent
  • are non-residual.

Foams are mainly used in moderately to heavily exudating wounds - including ulcers, donor sites and minor burns, and acts as a secondary dressing, particularly as a covering with the use of amorphous hydrogels. In addition to standard and waterproof foams, there are also shaped cavity devices which may be inserted into cavity wounds or dehisced surgical wounds.

Brand Type
Foam dressings

Allevyn Sheet™

Allevyn Gentle™

Allevyn Adhesive™

Allevyn Cavity™

Allevyn Life

Multiple layer

Multiple layer Silicone

Multiple layer waterproof

Dual layer cavity insert

Multiple layer Silicone

Cavicare™

Conforming Foam

Curafoam™ Single layer
Hydrasorb™ Single layer

Hydrocoll®

Hydrocoll Thin®

Multiple Sizes

Multiple Sizes

Lyofoam Max™

Permafoam®

Mepilex®

Mepilex Lite®

Mepilex Border

Multiple layer

Multiple layer waterproof

Multiple layer Silicone

Thin Multiple layer Silicone

Multiple layer Silicone waterproof

Alginate dressings (for wounds with medium to high exudate)

Alginates are the calcium or sodium/calcium salts of alginic acid, composed of manuronic and guluronic acids obtained from seaweed. When applied to a wound, the sodium salts present in the wound exchanges with the calcium in the alginate to form sodium alginate which is a hydrophilic gel. This gel has the ability to absorb exudate into itself while maintaining a moist environment at the interface between the dressing and the tissue.

Alginate dressings:

  • are highly absorbent
  • form a gel with exudate
  • create a moist interface
  • are easily removed
  • are haemostatic.

Alginates are used on donor sites, bleeding sites, exudating leg ulcers and cavities.  They are not considered to be of value in low exudating wounds or dry wounds with eschar. They come in a number of different forms, including sheets, packing rope and in combination with charcoal for exudating malodorous wounds.

Sheet alginates should be cut to the shape of the wound, placed on the wound and covered with a suitable secondary dressing (e.g. foam and non-stick dressings). They should then be held in place with tape, a cohesive or tubular bandage. If the wound is highly exudating then an outer absorbent pad may be added. In the case of a wet cavity wound, the rope or packing ribbon is gently placed into the cavity taking care not to pack the material tightly into the space. In general, alginates should be changed when they have fully converted to a gel, this will vary from 1 to 3 days depending on the level of exudate in the wound. When used on a donor site, the material is placed over the area after skin harvesting and covered with a film or a foam dressing, which can remain in place for up to 7 days.

Brand Type
Alginate dressings

Algoderm®

 

Kaltostat®

 

Carboflex(with charcoal)™

Surface sheet {firm gel}

Cavity Rope {firm gel}

Surface sheet{firm gel}

Cavity rope {firm gel}

Surface sheet

Seasorb Alginate™

Seasorb Alginate™

Cavity Rope {soft gel}

Surface sheet {firm gel}

Curasorb™

Surface sheet {firm gel}

Cavity rope {firm gel}

Sorbsan™

Surface sheet {soft gel}

Cavity rope {soft gel}

Tegaderm Alginate™

Algisite M™

Surface sheet and rope

Surface sheet {firm gel}

Cavity rope {firm gel}

Hydrofibre dressings

Hydrofibre dressings have some of the properties of alginates in that they are a fibre rope or dressing that forms a firm gel in contact with fluid.

Hydrofibre dressings:

  • are composed of a synthetic fibrous mat
  • form a firm gel in contact with exudate
  • are highly absorbent
  • have no lateral wicking - protects peri-skin

Examples of this product are Aquacel®, Aquacel Extra® and Aquacel Foam®

Hydroactive dressings (for wounds with medium to high exudate)

Hydroactive dressings are multi-layered highly absorbent polymer dressings with a surface adhesive and a waterproof outer layer are similar to hydrocolloids, however, instead of forming a gel in contact with exudate, the fluid is trapped within the product itself, to maintain a moist environment.

Hydroactive dressings are:

  • highly absorbent polymer dressings
  • waterproof
  • non-residual
  • semi-permeable

These dressings are indicated for use in highly exudating surface and cavity wounds including leg ulcers, pressure wounds and minor burns. They are particularly useful over joints such as elbows, knees, fingers and toes due to their ability to expand and contract without causing constriction. Hydroactive dressings are not indicated for dry or lightly exudating wounds.

Brand Type
Hydroactive dressings
Cutinova Hydro™ Surface sheet thick
Tielle™ Surface sheet
Biatain™

Surface sheet

Cavity dressing

PolyMem®

Surface sheet and

Cavity Dressing

Hydrogels (for dry or sloughy wounds)

Hydrogels are a group of complex organic polymers having a high water content ranging between 30 to 90 percent. This broad class of polymers swells extensively in water, but does not dissolve in water. They have the properties of both rehydrating dry tissue, and absorb certain amounts of fluid into themselves. They are provided as either amorphous gels or sheet gels. These products are used to help re-hydrate sloughy wounds and necrotic tissue to aid in the autolytic debridement of wounds. They are also used in the management of burns, including sunburn, scalds and other partial thickness burns. Amorphous hydrogels have also been used in the management of chicken pox and shingles, applied to the eruptions three to four times a day. They provide a moist environment and relieve the discomfort of the lesion, and also reduce the probability of scarring.

Hydrogels are also available in sheet form consisting of a cross-linked polymer and water held in a backing. These products are particularly useful in the management of burns, and also aid the removal of necrotic tissue in pressure wounds.

Brand Type
Hydrogel dressings
DuoDERM Gel® Amorphous non-preserved
Tielle™ Surface sheet
Safgel®

Amorphous preserved

Intrasite gel™

Amorphous non-preserved

Intrasite gel conformable™ Impregnated amorphous
Solosite™ Amorphous preserved
Curafil gel™ Amorphous preserved

Curafil Impregnated gauze™

Curagel™

Impregnated amorphous Sheet Gel
Purilon gel™ Amorphous non-preserved

Solugel™

Nu-gel™

Hydrosorb™

Amorphous both preserved and non-preserved

Sheet Gel

Sheet Gel adhesive and non-adhesive

Miscellaneous Dressings

Iodine

Povidone Iodine

Povidone Iodine, is a chemical complex made up of iodine and povidone (a polymer that slowly releases the iodine).  Iodine has a broad spectrum of activity against bacteria, mycobacteria, fungi, protozoas and viruses. There is no evidence of resistance to Iodine. It is a good skin antiseptic. On acute wounds apply for 3-4 minutes and wash off. For chronic wounds dilute to 0.5-1%.

Inadine

Inadine Dressing consists of a low adherent knitted viscose fabric impregnated with a polyethylene glycol (PEG) base containing 10% Povidone Iodine; equivalent to 1.0% available iodine.  It is indicated for the management of ulcerative wounds and may also be used for the prevention of infection in minor traumatic skin loss injuries.

Cadexomer iodine dressings (IodosorbTM

This is a non-toxic iodophor that combines iodine with a polysaccharide polymer. When applied to the wound, the exudate combines with the polymer and is absorbed at the same time as the iodine is released- over a period of 72 hours at a low strength.

Cadexomer Iodine was developed in the 1980’s and consists of cadexomer polysaccharide polymer and iodine 0.9%. The iodine is cross-linked into the structure of the polymer. Upon contact with a wound, this dressing:

  • is absorbent – forms a gel with exudate
  • releases iodine as gel forms
  • pulses iodine at 0.1% (not cytotoxic)
  • is used for sloughy/infected wounds, diabetic wounds, recalcitrant wounds
  • may stimulate growth factors.

Examples of products are IodosorbTM Comes as a Paste, Powder and a Dressing.

Silver

Silver has been used for many years, and has proven antimicrobial activity. It is broad spectrum and inactivates almost all known bacteria, including methicillin-resistant staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). No cases of bacterial resistance have been documented. Silver has been used in the treatment of burns as a silver sulfadiazine cream, and this cream has also been applied to some wounds. The difficulty in applying a cream to a mucous surface is that it will cause the development of mucilaginous slough. The development of a range of modern silver dressings overcomes this difficulty by delivering varying levels of silver directly from the dressing. The base dressings include hydrocolloids, alginates, tulles, hydroactives, foams, gels and polyethylene mats. The amount of silver and the method of action vary greatly between these dressings. Some release silver into the wound and some maintain the silver within the dressing and kill bacteria as they are absorbed into the dressing.

Silver product type Brand name
Silver dressings
High Density Polyethylene dressings ActicoatTM
Foam Dressing Mepliex AgTM
Alginate Dressing Acticoat AbsorbentTM
Foam Acticoat Moisture Control
Hydroactive Dressing Biatain AgTM
Hydrofibre Dressing Aquacel Ag®
Tulle Dressing AtraumanAg®

Fatty acid coated antibacterial fibre

This is a simple fibre coated with dialkylcarbamoylchloride (DACC) a fatty acid. Its mode of action is based on a physical process which make two hydrophobic (water-repellent) particles bind together when in contact, utilising the binding force of surrounding water molecules. The vast majority of pathogenic microorganisms are hydrophobic, and bind to the unique surface. The product is available as a ribbon for cavity use, a surface pad, a foam, a hydrogel and an adhesive dressing. It is used on infected wounds and also as a prophylactic treatment to prevent fungal infections of the toes and under the breasts.

Unlike traditional antimicrobial dressings, this product does not contain any chemically or pharmacologically active substances and relies on a physical mode of action using a hydrophobic coating made from dialkylcarbamoylchloride (DACC) to reduce the bacterial load in a wound. When two hydrophobic particles come in direct contact they bind together with the binding force of the surrounding water molecules. The product Sorbact® comes in many forms including: Tulle-like – Foam - Hydrogel – Absorbent – Ribbon - Post Op Dressing.

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Antiseptics

The role of topical antiseptics in chronic wounds is not as clear as in the case of acute wounds. There is a group of patients with long standing, non-healing leg ulcers. There are some clinicians who believe that one of the reasons for non-healing of these wounds is the presence of large numbers of colonised bacteria, especially in those patients who may be malnourished, diabetic or immuno-compromised.  In some of these patients, the use of a short course of dilute topical antiseptics may help reduce the surface flora and speed the process of wound healing. The decision should be made for the individual patient, taking into consideration all of the benefits and risks.

Wound type Management
Antiseptic
Cut/laceration Clean the area with water or saline. If there is any contamination, use a surfactant antiseptic
(e.g. Savlon® or Povidone Iodine scrub) to remove any foreign material that may be a focus for infection.
Cover with a simple dressing (e.g. a film dressing or island film).
Graze

Due to the presence in most grazes of dirt, gravel and other material, scrub the area with a surfactant antiseptic e.g. Savlon® or Povidone Iodine scrub.
Apply an antiseptic to the wound but wash off after 4 minutes and cover with either an island film dressing, thin hydrocolloid or foam.

Burn Most minor burns do not require the use of a topical antiseptic.  Their use will depend on the depth of the burn and if there is damaged and necrotic tissue present.
If there is, then the use of a silver dressing is considered appropriate in the early management.
If the burn is minor and there is little tissue damage (e.g. minor blisters) then apply an amorphous or sheet hydrogel.
Chroni wounds
(e.g.leg ulcers and pressure injury)

If the level of colonised bacteria is high, the short term use of Povidone Iodine Solution is the most effective antiseptic to use.
The recommendation is to use a low strength (e.g. 1%) solution and to apply for 3 to 5 minutes and then wash the product off.
Within this time the product will have significantly reduced the numbers of surface bacteria.

The other option is the use of IodosorTM being non-toxic.

Honey

Medicinal honey has an antibacterial and antifungal effect. Its action is bacteriostatic and produces hydrogen peroxide in “slow-release” form, but much of this is inactivated by the enzyme catalase Manuka honey, the activity is due to methylglyoxal which is not inactivated. Honey is a saturated solution of sugars with a strong interaction with water molecules, which inhibits the growth of microorganisms. Some patients experience pain with its use. Honey also has a low pH and may reduce odour. Not all forms of honey have effective antimicrobial activity. The only forms of honey that should be used on wounds are medicinal honey; the Manuka honey in the pantry is not suitable. The frequency of dressing changes will vary depending on the level of exudate in the wound.

There is high quality evidence that honey heals partial thickness burns around 4 to 5 days more quickly than conventional dressings. There is moderate quality evidence that honey is an effective antiseptic. The possible side effects of honey are:

  • allergic reaction, especially in people who are allergic to bees
  • risk of a rise in blood sugar

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Hypertonic Saline

Hypergranulation is generally treated with topical silver nitrate, an alternative, and less toxic method of application of a hypertonic saline dressing. These are applied to the hypergranulation and covered with a foam dressing and a compression bandage. The dressing is changed daily. Examples of this dressing are Mesalt which is available in a sheet or ribbon, and Cursalt which only comes in a sheet.

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Burns dressings

Once the burn has healed, retention tape for example Fixomull® and Hypafix®, may be applied directly to the skin to protect the new epithelium. The tape, once applied, remains in place for seven days at a time. It is removed by dissolving the adhesive in a fixed oil or citrus oil, allowing the tape to be easily removed without damaging the new epithelium. These retention tapes are permeable, allow exudate to flow through their surface, are flexible and although not waterproof may be washed after the first 48 hours of application and they will dry and remain in place.

It is also important to cover the dressing with a cohesive bandage to apply some compression to the skin.

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Keloid and hypertrophic scar management

A topical method for treatment of keloid and hypertrophic scars is the use of a silicone dressing. The dressing is applied to the scar initially for 4 hours and then progressively increasing the contact to 24 hours. The scar may gradually reduce in depth and colour. This will however, be a slow process requiring application for six months or more. Examples of this type of dressing are Cica CareTM and Mepiform®. There are also Silicone gels e.g. Stratamed gel. To prevent hypertrophic scaring when sutures or clips are removed place strips across the incision line and cover with a film dressing.  This is changed every 7 to 10 days, and continued for 8 weeks.  Following this, remove strips over the next few dressing changes and continue with film for 4 to 6 weeks.

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General rules for sheet dressing use

  • Attend to the patient first, not the wound
  • Allow 2-3cm of dressing greater than wound size
  • Place the dressing 1/3 above & 2/3 below the wound to allow more capacity to absorb exudate, which increases wear time
  • Remove when strike-through occurs (this is when exudate is close to the edge of the dressing)
  • Remove with care, particularly in patients with fragile skin
  • In some circumstances, the dressing can be safely and conveniently removed under the shower
  • Do not pre-moisten alginate dressings
  • Promote recovery and rehabilitation

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Frequency of dressing changes

Dressings may be left intact for up to 7 days. The decision to change them will depend on the wound type and location, assessment of the wound bed and patient, the volume of exudate and the ability of the dressing or device to promote healing and protect the surrounding skin. Disturbances to wound temperature and granulating tissue is minimised by less frequent dressing changes.

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Bandages

The use of material to bind a wound is as ancient as medicine itself. Techniques and material have changed little over the centuries, but in the past fifteen years there has been an explosion in the type of bandages available.

When choosing and applying a bandage it is important to differentiate between the traditional and the ritual and what is best and most cost effective for the patient.

The bandage may be needed for keeping a dressing in place, supporting an injured joint or assisting venous return.

Retention bandages

The role of retention bandages is to hold a dressing in place. They are of particular use where a patient has very fine and very friable skin that is easily damaged if the dressing was held in place with any type of adhesive tape or other adhesive product. For many years, the purpose of cotton crepe bandages have been used to hold dressings in place. However, today there are a number of more effective and appropriate bandages that may be used.

The first is the lightweight conforming cohesive bandage. This bandage is a lightweight crepe coated with a thin latex.  As a result of this coating the bandage sticks to itself but not to skin, hair or clothing. Only a very small length is required to hold the dressing in place, compared with using a complete roll of a standard crepe bandage. This type of bandage comes in widths that are appropriate for fingers, toes, and limbs and larger sizes for the head. The other advantage is that the same amount is not required to hold the dressing in place compared with using a standard crepe bandage. This makes this type of bandage less bulky and very cost effective.

Examples of this type of bandage are Handigauze Cohesive®, Easy Fix Cohesive® and Peha-Haft®.

The other type of product is the elasticised tubular bandage available in a light weight form that may be cut to the required size and placed over the dressing, again holding it in place.  An example of this is Tubi FastTM.

Support bandages

Support bandages are of a heavier construction and are made from both natural and synthetic fibres. They achieve their stretch by the use of high twist yarns and the heavier construction. The main role of strong support bandages is the support of joints in strains and also in the management of muscular injuries. Strong support bandages can be used singularly or in combination to restrict movement, help reduce some of the oedema and act as a mechanism of support following soft tissue injury. Examples of this type of bandage are the heavy duty crepe bandage such as Elastocrepe® and Handycrepe®, and the heavier weight cohesive bandage (e.g. CobanTM, Coplus®, Handygrip®).  Single layers of the heavier weight tubular bandage may also be used for this purpose (e.g. Tubi GripTM, Handyplast Tubular® or Tensogrip®).

Other bandages

Bandage type Description and use Brand name
Bandage type and use
Crepe This bandage is not considered appropriate for the management of leg ulcers of venous disease.
Has little use as a retention bandage as it is bulky.

Handycrepe®
Elastolite Crepe®

Light Cohesive Retention Bandage

Light weight cohesive bandages are the most appropriate as they stick to themselves and not to the skin and
only require two layers so there is no bulk.
Helpful for patients with friable skin.

Esifix Cohesive ®
Handygauze cohesive®
Peha-haft®

Tubular stocking bandages

Tubular stocking bandages are conforming and require only one layer.
Also helpful for patients with friable skin.

Tubifast®
Tubular Band®

Tubular Support Bandages

A bandage with some compression however uniform in nature. They can be used for musculoskeletal support.
Each layer provides 8mm of mercury.

TubiGrip®
Tensogrip®
Tubular Form®

Elasticated Support Bandages

Support bandages are of a heavier construction containing elastomers, combined with natural and/or synthetic fibres.
These maintain a pressure level nearer to that immediately following the application than with an elasticated bandage.
Strong support bandages can be used singularly or in combination to restrict movement, prevent oedema or act as a mechanism of support

following soft tissue repair or injury.

Coban®
CoPlus®

Compression bandages

The action of compression bandages is to provide pressure firm enough to compress the pathologically distended veins thus enabling the valves to remain tightly against the wall of the vessel, increasing velocity of the venous blood stream and normalising the returned flow of blood to the heart.

Accumulated fluid and waste products are removed from the affected tissue by the accelerated rate of flow resulting from application of a pressure bandage.

Effective therapeutic compression starts with a sub-bandage pressure of 18mm of mercury at the ankle. Anything giving a lower value may be appropriate for support, but is not considered appropriate in the treatment of venous leg ulcers.

The primary aim of compression is to reduce pressure in the superficial veins in order to encourage venous return to the heart. This is performed by increasing the velocity of flow in the deep veins and discouraging oedema by reducing the pressure difference between the capillaries and the tissues.  The most effective method is to apply graduated compression from the toes to the knee. The highest pressure should be exerted at the ankle, gradually falling to 50 percent at the knee. Anti-embolic stockings should only be used for the prevention of deep vein thrombosis in hospitalised patients. The stockings provide a pressure of between 12mm and 18mm of mercury.

The hazards of compression bandages

Care must be exercised when applying compression bandages to ensure there is adequate arterial blood flow. The application of compression can cause skin necrosis, trauma, ulceration, or even amputation (this may result from damage caused by lack of arterial blood in the area). If arterial supply is uncertain then order an Ankle Brachial Pressure Index Test (ABPI).

An alternate method of applying graduated pressure to the leg is through the use of compression stockings. Stockings may be used as part of the treatment of venous leg ulcers, as an ongoing management modality of venous disease, and/or for the prevention of venous stasis.

The use of compression stockings both as a preventive measure and to minimise the risks of venous stasis is common. The difficulty is that there is considerable confusion as to the appropriate type of stocking to use and the level of compression necessary for best treatment.

For the prevention of Deep Vein Thrombosis in patients undergoing surgery, systemic medication (e.g. Low Molecular Weight Heparin) is used with calf stimulation. The use of anti-embolic stockings is no longer recommended. Class one compression stockings can be worn by non-ambulatory patients in hospital pre and post-surgery to help prevent DVTs in combination with Low Molecular Weight Heparin. It should be noted that anti-embolic stockings are not suitable for the treatment or management of venous disease.

Compression stockings have a major role to play in the prevention of venous stasis. They should also be worn when travelling long distances to minimise oedema and thrombosis development. For compression to be effective it must be at least 18mmHg.

Compression bandages are divided into two types: high stretch compression and short stretch.

High-stretch compression bandages

High-stretch compression bandages have an extension from 130 percent to 200 percent, high elasticity, medium to high resting pressure, and medium to high working pressure. They exert their effects superficially, working in combination with the muscles. They are indicated for venous oedema and the management of venous ulcers and may be left in place for 24 hours.  Examples include Tensopress®, Setopress™, Surepress® and Eloflex®.

Low-stretch compression bandages

Low-stretch compression bandages have an extension of 30 percent to 90 percent, low elasticity, low to slight resting pressure, but high to very high working pressure. They exert their main effects deep within the limb and are indicated for venous oedema and lymphoedema and may be left in place for 24 hours.  Examples of this type of bandage are Comprilan®, Lastolan® and Tensolan®.

Application methods include the simple spiral method which is performed by applying the bandage with a figure eight at the ankle, and continuing up the limb in a spiral application covering 50 percent of the previously bandaged area. The application is generally undertaken with the high stretch type of bandage.

A continuous figure eight method of application is performed by overlapping as the bandage is wound up the leg so that it is applied in one direction and then in the opposite direction, producing a V shape in the bandage. This method is used particularly with low stretch compression bandages.

A development in bandaging has been the introduction of the Charing Cross 4 layer system. This combines an orthopaedic wool, crepe, elastic and cohesive bandage in multiple layers. This achieves 40 mm of mercury at the ankle, graduating to 17mm of mercury at the knee. A number of published studies have shown good healing rates in 12 weeks with this particular system. The commercial brands of this type of bandage system are ProforeTM, Profore LiteTM, Coban 2TM and Veno-4TM.

If it has been clearly demonstrated by Doppler and/or Duplex scanning that if a true venous pathology exists, compression bandaging is then used in combination with management of the wound by appropriate dressings, using either a high or low stretch compression bandage.

Where there is some indication of minimal arterial involvement, compression is provided by the use of a straight tubular bandage. Where more significant arterial disease is present, no compression is applied over the dressing.

Bandage type Description & use Brand name
Types of compression bandages
High Stretch Elastic bandage

These have high elasticity containing elastomers, medium to high resting pressure and medium to high working pressure. 

They exert their effects mainly superficially veins working in combination with the muscles. 

SurePress®
Tensopress®
Setopress®

Inelastic Low Stretch/  

High stiffness bandage

These have a low elasticity, low to slight resting pressure but high to very high working pressure. 

They exert their effects mainly deep within the limb.  They are indicated for venous oedema and lymphoedema. 

Lastolan®
Comprilan®
Acrylastic®

Multi-layer bandage

Uses 2 tor 4 layers of bandages to build up the compression level.

Combination of elastic and inelastic bandages and padding.

Coban 2TM
ProforeTM
Veno4®

Hosiery

Stockings are available ready-made or custom made.  They come as single or double layer. There are 3 classes:

Class 1. 18-24mmHg

Class 2  25-35mmHg

Class 3  35-435mmHg

The decision on stocking type will depend on the patient and the level of varices, oedema and previous DVT.
Please note anti-embolic stockings are NOT compression stockings

JOBST®
VENOSAN®
SIGVARIS

Multi Length Tubular Bandages

3 layers of straight tubular elasticated bandage cut at different lengths placed over each other:

  1. Full-length toe to knee,
  2. Toe to mid-calf
  3. Toe to 4cm above ankle bone

Each layer provides 8mmHg x3 =24mmHg.

There is also a shaped single layer tubular bandage providing 18-24mmHg.

TubiGrip®
Tensogrip®
Tubular Form®
Tubigrip shaped support bandage®

Tubular Form SSB®

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Zinc paste bandages

Zinc has been used in medicine for hundreds of years, even though very little published data of its pharmacology is available. Zinc is an important trace element in many functions of the body.  In wound healing it is essential for cell proliferation and tissue regeneration, and is also involved in collagen synthesis and epithelialisation.

There are a number of commercial zinc paste bandages available on the Australian market. These include: Zincaband™ and Viscopaste™ and ZipZoc™, and Gelocast®.

The bandage can be applied to the limb, as a patch over the wound or as a full length bandage. A water-based zinc paste bandage with no preservatives is beneficial in the management of chronic venous leg ulcers, particularly where venous eczema is present and when used in conjunction with appropriate compression bandaging.

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