DRESSINGS AND BANDAGES

Claudia Gherman, Răzvan Ciocan

Learning objectives
What you should know
 What is a dressing
 What is a bandage
 The basic principles of a bandage
 Indications of a bandage
 Types of bandages
 Bandaging modalities
 Special types of dressings

What you should do

 List the indications of a bandage
 List the types of bandages
 Apply a circular bandage
 Apply a spiral bandage
 Apply a spica bandage
 Apply a figure-of-eight bandage
 Apply a capeline bandage
 Apply a bandage on one or more fingers
 List and describe the special types of dressings

Definitions
A dressing is used to isolate a treated wound in order to
allow healing. Dressings are most frequently made of sterile
gauze, but other materials are also used. In addition to isolating
the wound, dressings allow absorption of secretions and a certain
protection against microbial contamination and trauma.
A correct dressing should respect several principles:
 Any dressing will be applied with the patient in lying position,
rarely in sitting position, and never in standing position
o Patients can be impressed by the surgical dressing room,
by instruments, and can lose consciousness and suffer
trauma from falling; the lying or sitting position allows to
eliminate this risk
 The application of a dressing requires two persons: a person
applies the dressing, and the other person provides the
necessary materials
o This ensures not only the comfort of the procedure, but
also the maintenance of asepsis
 A kidney tray will also be available, in which the removed
dressing and the used compresses will be placed
 Perfect asepsis: the instruments and materials used must be
sterile; hand washing before and after the application of a
dressing, as well as wearing of gloves (sterile – if the dressing
involves manipulation of tissues with the hands, or non-sterile
– if materials and tissues can be manipulated using hemostats)
is compulsory
 Absorption of secretions will be ensured: gauze compresses,
etc.
 Asepsis of the wound will be performed with antiseptics
adequate for its evolution stage
The dressing will be secured with:
 Silk, cloth or paper surgical tape
o Which has advantages:
 It allows easy wound monitoring
 It does not interfere with the functions of the
anatomical segment concerned
o But also has disadvantages:
 Removal is painful
 Sometimes it causes maceration of the underlying
tissue or local reactions (erythema, pruritus)
 Bandages
Bandages or surgical wrappings represent a method for
securing dressings, for temporary immobilization or compression
of different body regions.

Simple dressings
The instruments currently used for dressings are:
 Surgical hemostat
 Anatomical hemostat
 P•an’s forceps
 Kocher’s forceps
 Scissors
 Kidney tray
 Figure 1. Instruments currently used for dressings: P•an’s forceps, Kocher’s
forceps, scissors, surgical hemostat, anatomical hemostat, kidney tray (from
left to right)

Dressing technique:
 Hand washing and gloving
 The old dressing is gently removed
o If this is stuck to the wound, it is moistened with
oxygenated water or physiological serum
 The skin around the wound is cleaned with a swab soaked in
gasoline for degreasing
o Application is performed from the wound to the periphery
so as not to contaminate the wound
 The skin around the wound is disinfected with alcohol or
betadine
 The wound is treated depending on its nature and evolution
stage
o Surgical wounds with aseptic evolution do not require
special treatments
o Secreting wounds will be cleaned by washing with
antiseptic solutions
o Seromas and hematomas will be drained using a bulb-
headed or a hollow probe, after removing 1-2 sutures
o Purulent collections will be widely opened and drained
with tubes
 Wound protection starts with the application of 2-3 gauze
compresses
o For secreting wounds, an additional layer of compresses is
applied (thickness depending on the amount of secretions
in the wound)
 The dressing is secured with surgical tape or bandage
 Special types of dressings
Grassolind sterile compress
It is a sterile
dressing impregnated
with a paraffin-based
fat substance. It is
made of a network of
meshes that allow the Figure 2.
Grassolind dressing
exudate to pass,
Preventing maceration. It stimulates
epithelization and granulation tissue formation. It
is used to cover wounds, burns.

Hydrogel dressing
It absorbs secre-
tions and maintains
wound moisture, stimu-
lates healing, and does
not adhere to the
wound. It is used for
Superficial or deep Figure 3. Hydrogel dressing
Wounds and burns up to grade 2.

Sterile gel (Hydrosorb Gel)

It is an absorbent polyurethane gel,
permeable for gases and vapors and
impermeable for germs and fluids; it is
available in syringes. The gel softens
necrotic tissue and facilitates its removal
(debridement), incorporating the exudate
and wound debris. It is used for uninfected Figure 4.
wounds and for burns. Polyurethane gel

Calcium alginate fiber dressing

It is a hydroactive dressing made of calcium alginate
fibers. It is indicated for deep, difficultly accessible wounds,
infected chronic wounds, fistulas.
 Figure 5. Calcium alginate fiber dressing

Silver ion dressing

It is a mesh
dressing impregnated
with triglycerides and
stratified with silver
ions. It is used in
infected wounds or Figure 6.
wounds at risk for Silver ion dressing
infection, burns.

Indications of bandages
 To prevent contamination of a wound by maintaining sterile
compresses in place
 To maintain a dislocated or a fractured limb in place
 To prevent or control hemorrhage
 To restrict joint movements
 To correct a deformity
 To maintain adequate pressure (elastic bandages applied to
improve venous return)

Types of bandages
 Light gauze bandages
 Simple elastic bandages

A. B.
Figure 7. Types of bandages: A. Gauze bandage; B. Elastic bandage
 Compression bandages
 Orthopedic bandages
 Mesh bandages
A. B. C.

Figure 8. A. Plaster bandage; B. Mesh bandage; C. Sterile compresses

Principles of bandages
 The patient should be in a comfortable position.
 The injured region should be supported during bandaging (if a
joint is involved, this should be maintained in semiflexion).
 The bandage should be of an appropriate size and material.
The recommended size of different bandages is indicated in
the table below.

Table 1. Size of adequate bandages for different anatomical regions

Anatomical region Width (cm) Length (m)
Head 5 4-6
Chest and abdomen 10-15 6-8
Upper limb 6-8 4
Lower limb 5-6 3-4
Fingers 2.5 2
Hand 5 3
Radiocarpal joint 5 3

 The bandage roll is held in the dominant hand, with the rolled-
up portion towards the palm. In this way, the roll is held more
firmly and the risk to drop it is lower.
 Attention should be paid to avoid the formation of folds that
can make circulation difficult or can induce pain.
 During bandaging, constant tension on the bandage is
maintained – not too high, not too low.
 In the end, the bandage is secured by applying a surgical tape
or pliers.
 During and at the end of bandaging, the temperature of the
extremity, its color, pulse, the possibility to move the body
region concerned are checked.

Bandaging modalities
The main bandaging modalities are:
 Circular bandage
 Spiral bandage
 Spica bandage
 Figure-of-eight bandage
 Recurrent fold bandage
 Fan-shaped bandage (rarely used because it is unstable)

A. B. C. D. E. F.

Figure 9. Types of bandages: A. Circular bandage; B. Spiral bandage; C.

Figure-of-eight bandage; D. Spica bandage; E. Fan-shaped bandage; F.
Recurrent fold bandage
Circular bandage
It is applicable in the case of small wounds. Circular
bandaging is applied only in the affected area. It provides
effective support of the injured part, being useful in wounds of the
lower limbs, upper limbs, fingers and toes.
Circular bandaging is
used to start any bandage. A
number of circular turns are
applied proximally to the area
concerned, which have the role
to secure the bandage. A corner
of the bandage is folded over
the first turn and then covered
by the second turn; in this way, Figure 10. Any bandage starts with
the bandage becomes more circular bandaging; folding of a
stable. bandage corner secures the bandage in
place.
 Spiral bandage
After securing the bandage by circular turns, oblique turns
are performed so as to cover 1/3 of the previous turns. This type
of bandage is indicated to be used for upper and lower limbs.

Figure 11. Spiral bandaging

Spica bandage and figure-of-eight bandage

They are used particularly for the hand, radiocarpal joint,
ankle.
Spica bandage: it is
initiated by circular turns
above the joint, to anchor the
bandage, after which the
bandage is advanced in the
shape of an eight, each turn
covering 1/3 or 2/3 of the
preceding turn. The bandage is
completed by circular turns on
the support point. Figure 12. Spica bandage
Figure-of-eight
bandage: it starts with circular
turns below the joint, after
which the turns are continued
obliquely over the joint, and
the bandage is advanced by
other circular turns above the
joint. The bandage returns
obliquely on the opposite side, Figure 13. Figure-of-eight bandage for
crossing the first ascending the radiocarpal joint combined with
turn, then it continues in the circular bandage for the second finger,
shape of an eight, covering half using the third finger as a splint
Of the preceding turn. This continues several times, and the
bandage ends above the joint with circular turns.

Figure 14. Figure-of-eight ankle bandage technique

Capeline bandage
It is a head bandage. It starts
by two circular turns over the
forehead and the occipital region,
then by parallel turns from anterior
to posterior direction, which overlap
over 2/3 of their width. At the end,
another two circular turns are
performed to maintain in place the
ends of the parallel turns, and the Figure 15. Capeline bandage
Bandage is secured with surgical tape.
 Figure 16. Capeline technique

Amputation stump bandage

For amputation stump bandaging, several recurrent turns
over the stump are secured with several circular turns (similarly to
the capeline technique).

Figure 17. Amputation stump bandage

Finger bandage
In the case of fingers, spica
bandage is difficult to apply, and
spiral bandage is unstable. To
bandage a finger, a combination of
recurrent fold bandage and circular
bandage is preferred. The bandage
is passed over the end of the finger
Several times; then, several circular Figure 18.
turns are made to secure it. In Finger bandage
Fact, it is the same technique as the capeline or the amputation
stump bandaging technique.

Nose and chin bandage

A sufficient length of bandage is cut from a bandage roll
with a 5 cm width. Two median incisions are cut at both ends
with scissors, leaving a sufficient portion to cover the wound. The
bandage is placed in position and is secured by tying the lower
ends in front of the ears and the upper ends at a 90ƒ angle in
relation to these, below the ears.

Figure 19. Nose bandage and chin bandage

Dessault’s bandage
It is used for shoulder immobilization – for example, after
reduction of a scapulohumeral dislocation. It immobilizes the arm
against the chest (preventing arm abduction), and supports the
arm (lifting it towards the shoulder).
The affected arm is positioned against the chest and the
forearm is flexed at 90ƒ. The bandage starts with two circular
turns over the arm and chest. Then, it continues over the shoulder
at 45ƒ in relation to the first two turns, and descends towards the
elbow to maintain it at a right angle.
 Figure 20. Dessault’s bandage

Assessment / self-assessment form

Stage / Criterion Correct Incorrect

Apply a circular bandage
Apply a spiral bandage
Apply a spica bandage
Apply a figure-of-eight bandage
Apply a capeline bandage
Apply a bandage on one or more fingers
Apply a Dessault’s bandage
List the basic principles of a bandage
Illustrate the special types of dressings
For each bandage:
 Position the patient
 Keep the roll with the rolled-up portion towards the palm
 Perform the initial turn to secure the bandage
 Apply the bandage
 Complete the bandage