Compression Bandaging

Original Editor - Alicia Fernandes Top Contributors - Alicia Fernandes, Kim Jackson and Ewa Jaraczewska

Introduction

Compression bandaging is a vital aspect of physiotherapy interventions, particularly in the management of edema and venous insufficiency. This article aims to explore the techniques, uses, indications, and red flags associated with compression bandaging.

Types of Compressive Bandages

1. Elastic Bandages:

•    Description: Elastic bandages are commonly used for providing compression and support to injured or strained areas.
•    Material:Typically made of stretchable fabric such as cotton, polyester, or a blend.
•    Application:Applied with varying degrees of tension, these bandages conform to the body's shape and provide adjustable compression.
• Use Cases: Suitable for sprains, strains, edema management, and securing dressings.

2. Crepe Bandages:

•   Description: Crepe bandages are woven with a crinkled texture, providing moderate compression and support.
•   Material:Made from cotton or a cotton-polyester blend.
• Application: Applied with moderate tension, crepe bandages are effective for securing dressings and providing light to moderate compression.
• Use Cases:Often used for joint support, strains, and minor injuries.

5. Multi-layer Compression Bandages:

Multilayered bandaging involves the application of several layers of compression bandages to effectively manage venous leg ulcers. These layers typically include padding, a crepe bandage, and cohesive or adhesive bandages.

• Padding:The first layer consists of a soft padding material, such as orthopedic wool or foam, which provides cushioning and protection to the wound site.
• Crepe Bandage:Over the padding, a crepe bandage is applied to provide initial compression and support. Crepe bandages are elastic and conform well to the shape of the leg, helping to maintain consistent pressure.
• Cohesive or Adhesive Bandages:Finally, cohesive or adhesive bandages are applied over the crepe bandage to provide additional compression and secure the layers in place. These bandages adhere to themselves without the need for pins or clips, ensuring that the compression remains uniform.

The multilayered bandaging technique aims to promote venous return, reduce edema, and facilitate wound healing by applying graduated compression to the affected limb. This method has been found to be effective in managing venous leg ulcers and preventing recurrence.

Understanding Compressive Bandages: Short Stretch vs. Long Stretch

Long-Stretch Bandages:

• Elasticity:Long-stretch bandages are composed of elastic materials with high elongation capacity (exceeding 100%).
• Resting Pressure:They offer less tolerable resting pressure compared to short-stretch bandages.
• Continuous Pressure: Long-stretch bandages provide continuous pressure during movement and exercise.
• Smooth Application:Due to their elastane filament composition, long-stretch bandages offer smooth application and conformability, making them suitable for daily wear.
• Ideal for Mobile Patients: They excel in sustaining pressure during movement, making them ideal for patients who are active.
• Usge:Long-stretch bandages are commonly used for conditions where continuous pressure during movement is required, but they may be less effective in managing edema compared to short-stretch bandages.

Short-Stretch Bandages:

• Material: Short-stretch bandages are composed of non-elastic or rigid materials with an elongation capacity ranging from 10% to 100%.
• Pressure:They exert higher working pressures compared to long-stretch bandages.
• Resting Pressure: Short-stretch bandages have low resting pressure and high working pressure.
• Tissue Hydrostatic Pressure:These bandages effectively limit the available space for fluid accumulation and promote tissue hydrostatic pressure.
• Fluid Drainage: Short-stretch bandages facilitate fluid drainage, reinforce tissue hydrostatic pressure, and improve venous and lymphatic flow.
• Usage: Short-stretch bandages are preferred for conditions where high working pressure is required, such as managing edema and promoting venous return.

Techniques

Based on the literature review conducted by Fulcher and Gopee (2020), various techniques of compression bandaging were identified, particularly focusing on four-layer and two-layer compression systems for the treatment of venous leg ulcers (VLUs).

Different techniques within these compression systems include:

• Four-layer Compression Bandaging:This technique involves the application of multiple layers of bandages, typically comprising a non-adherent wound contact layer, a padding layer, a light compression layer, and a final high-compression layer.
•  Two-layer Compression Bandaging: In contrast to the four-layer system, the two-layer technique involves the application of only two layers of compression bandages, usually consisting of a padding layer and a cohesive compression layer.

Other potential techniques and considerations in compression bandaging may include:

• Application Technique: Proper application techniques are crucial to ensure uniform pressure distribution and prevent constriction or discomfort.
• Choice of Material:The type of materials used in the bandages, such as elastic or non-elastic materials, can influence the effectiveness and comfort of the compression therapy.
• Bandage Configuration: Variations in bandage configurations, such as the number of wraps, tension applied during application, and overlap of layers, can impact the efficacy of compression therapy.

Overall, the selection of a specific compression bandaging technique should be guided by factors such as the patient's condition, preferences, comorbidities, cost considerations, and the desired outcomes in terms of healing rates and quality of life.

Uses

• Management of Venous Insufficiency:Compression bandaging is commonly used in the management of conditions such as venous insufficiency and venous leg ulcers by applying external pressure to the limb, promoting venous return, and reducing edema.
• Promotion of Wound Healing: Compression bandaging helps in promoting wound healing by improving tissue oxygenation, facilitating the removal of excess interstitial fluid, and enhancing the delivery of nutrients to the wound site.
• Prevention of Recurrence: Compression bandaging plays a crucial role in preventing the recurrence of venous leg ulcers by maintaining adequate pressure on the limb, preventing venous pooling, and minimizing the risk of further tissue damage.
• Edema Management: Compression bandaging is effective in managing edema associated with various conditions such as lymphedema, post-surgical swelling, and traumatic edema by assisting in fluid mobilization and drainage.
• Supportive Therapy:Compression bandaging can provide support and stability to the affected limb, particularly in individuals with compromised mobility or muscle weakness, aiding in functional rehabilitation.
• Enhanced Patient Comfort: Properly applied compression bandages can alleviate discomfort associated with swelling and improve overall patient comfort and mobility.

Red Flags

While compression bandaging is generally safe, certain red flags warrant attention:

• Arterial Disease Patients with severe arterial disease, such as arterial insufficiency or peripheral artery disease (PAD), are identified as having a contraindication to medical compression treatment. Compression therapy in these patients can exacerbate ischemia and compromise arterial blood flow.
• Acute Deep Vein Thrombosis (DVT):n patients with acute DVT, particularly during the acute phase of the condition. Compression therapy in this context can dislodge thrombi and increase the risk of embolization or other complications.
• Untreated or Uncontrolled Infection: Patients with untreated or uncontrolled infections in the affected limb should not undergo compression therapy. Compression bandaging over infected areas can promote bacterial growth and exacerbate inflammation.
• Skin Conditions: Patients with compromised skin integrity, such as dermatitis or open wounds, may experience further damage or irritation from compression therapy. Careful assessment of skin condition is essential before initiating compression treatment.
• Peripheral Neuropathy: Patients with peripheral neuropathy, particularly those with diminished sensation or neuropathic ulcers, are at increased risk of pressure-related injuries from compression therapy. Close monitoring is necessary to prevent complications in these patients.

Monitoring and Evaluation

Monitoring and evaluation of patients undergoing compression therapy involve:

• Regular assessment of limb circumference, comparing measurements over time to track changes in edema.
• Evaluation of skin condition beneath the bandage for signs of pressure damage, irritation, or allergic reactions.
• Subjective assessment of patient-reported symptoms such as pain, discomfort, or changes in sensation.
• Utilization of objective measures like ankle-brachial pressure index (ABPI) to assess vascular status and ensure adequate perfusion

Patient Education

Patient education in compression bandaging should encompass:

• Proper limb elevation techniques to enhance venous return and reduce edema.
• Skin care practices including moisturization, hygiene, and protection against trauma.
• Recognition of warning signs such as increased pain, numbness, tingling, skin changes, or temperature abnormalities, warranting prompt medical attention.
• Instructions on bandage care, including hygiene, avoidance of excessive moisture, and proper reapplication techniques .

Compression bandaging for the treatment of breast cancer-related lymphedema (BCRL).

Spiral Method:

• Technique: Involves bandaging the affected limb in a spiral manner, applying the bandage in one direction around the limb.
• Uses: Widely used in lymphedema treatment as part of complex decongestive therapy (CDT).
• Effect: Provides light pressure during rest and higher pressure during muscle contraction to facilitate passive lymphatic flow. It helps maintain reduced volume following manual lymphatic drainage (MLD)
• Comparison:

   - Ease of Application: Simple to apply as it involves wrapping the bandage in one direction.

   - Patient Comfort: Generally associated with higher patient satisfaction due to its ease of application.

Spica Method:

• Technique: Involves bandaging the affected limb in a zigzag or crisscross manner, applying the bandage diagonally across the limb.
• Uses: Utilized when firm fixation of the bandage is required, preventing loosening, especially in areas prone to movement.
• Effect: Provides consistent pressure across the limb, effectively reducing edema. It can be particularly beneficial for maintaining compression over the proximal part of the limb.
• Comparison:

   - Application Difficulty: More challenging to apply compared to the spiral method due to the zigzag pattern.

   - Patient Comfort: May cause discomfort due to the tightness of the bandage and the need for more time-consuming application.

Comparison:

• Compression Effectiveness: The spica method has been shown to result in better volume reduction, especially in the proximal part of the limb, compared to the spiral method.
• Patient Satisfaction: While the spiral method may be preferred by patients for its simplicity and comfort, the spica method demonstrates superior efficacy in reducing edema.
• Application Difficulty: Spiral method is easier and quicker to apply, making it more convenient for both patients and healthcare providers.
• Clinical Considerations: The choice between the two methods should consider the patient's comfort, compliance, and the clinical requirement for firm compression, especially in cases where proximal edema reduction is a priority.

In summary, both the spiral and spica methods are effective in compression bandaging for BCRL treatment. The choice between them depends on factors such as the patient's comfort, the need for firm compression, and the desired outcome in terms of volume reduction across different parts of the affected limb.

Safety Considerations in Compression Bandaging for Lymphedema Treatment

While compression bandaging is considered a cornerstone in the management of lymphedema, it is essential to recognize the potential risks associated with its application by untrained clinicians. Improperly applied compression can lead to adverse effects, including skin damage, circulation impairment, and exacerbation of lymphatic fluid buildup.

This highlights the critical importance of proper training and expertise in compression bandaging techniques. Clinicians should undergo comprehensive education and hands-on training to ensure proficiency in assessing patient needs, selecting appropriate bandaging materials, and applying optimal pressure levels. Moreover, regular monitoring and evaluation during treatment are vital to detect any complications early on and adjust the bandaging regimen accordingly.

By prioritizing safety and expertise in compression bandaging, healthcare providers can maximize the therapeutic benefits while minimizing the risks for patients with lymphedema.

Conclusion

In summary, compression bandaging is a crucial aspect of physiotherapy, aiding in the management of edema, venous insufficiency, and wound healing. With various bandage types and techniques available, tailored approaches can be implemented for individual patient needs. However, vigilance for contraindications and adherence to safety protocols are essential. By combining evidence-based practices with patient-centered care, physiotherapists can optimize outcomes and promote patient comfort and mobility effectively.