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

The application of compression bandages requires a thorough understanding of the underlying condition and the patient's needs. Several techniques exist, including:

1. Spiral Technique: This involves applying the bandage in a spiral pattern, ensuring even pressure distribution along the limb.

2. Figure-of-Eight Technique: Here, the bandage is applied in a crisscross pattern, resembling the figure-of-eight, providing additional support and compression.

3.Modified Robert-Jones Bandage: This technique involves multiple layers of padding followed by a tightly applied bandage, commonly used in the management of acute injuries.

Uses

Compression bandaging serves various purposes in physiotherapy practice:

1. Edema Management:It is effective in reducing swelling associated with acute injuries, chronic conditions like lymphedema, or post-surgical swelling.

2. Venous Insufficiency:Compression bandaging aids in improving venous return, reducing symptoms of venous insufficiency such as pain, swelling, and skin changes.

3. Joint Stability: In cases of ligamentous injuries or joint instability, compression bandaging provides external support, enhancing proprioception and stability.

4. Ulcer Healing: For individuals with venous ulcers, compression bandaging promotes wound healing by improving circulation and reducing edema.

Indications

Compression bandaging is indicated in various clinical scenarios, including:

1. Chronic Venous Insufficiency:Patients presenting with symptoms like leg swelling, varicose veins, and venous ulcers benefit from compression therapy.

2. Lymphedema:Management of lymphedema involves complex decongestive therapy, including compression bandaging, to reduce limb swelling and improve lymphatic drainage.

3. Acute Injuries:Following acute trauma such as sprains, strains, or fractures, compression bandaging helps control swelling and provides support during the healing process.

4. Post-Surgical Care:After orthopedic surgeries or procedures involving extensive tissue manipulation, compression bandaging aids in reducing post-operative edema and promoting tissue healing.

Red Flags

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

1. Excessive Pain: Persistent or increasing pain beneath the bandage may indicate compromised circulation or excessive pressure, requiring immediate assessment.

2. Numbness/Tingling: Sensory changes like numbness or tingling suggest nerve compression and necessitate bandage adjustment to alleviate pressure.

3. Skin Changes:Signs of skin irritation, blistering, or discoloration beneath the bandage may indicate skin compromise or allergic reactions.

4. Temperature Changes: Significant temperature changes in the affected limb, such as increased warmth or coolness, can signal vascular compromise or infection.

Contraindications

In addition to arterial insufficiency, acute deep vein thrombosis, and severe peripheral neuropathy, contraindications to compression bandaging may include:

• Compromised skin integrity such as dermatitis, open wounds, or fragile skin.
• Acute inflammatory conditions where compression may exacerbate swelling and pain.
• Allergic reactions to bandage materials, adhesive components, or topical agents used under the bandage .

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 .

Advanced Techniques and Modalities

Advanced techniques and modalities in compression therapy may include:

• Intermittent pneumatic compression devices (IPC) which intermittently apply and release pressure to the limb, enhancing venous return and lymphatic drainage.
• Multi-layer compression systems combining different materials and bandage layers to provide graduated compression and optimal pressure distribution.
• Custom-made compression garments tailored to individual patient needs and anatomical considerations, offering a precise fit and enhanced comfort.
• Neuromuscular electrical stimulation (NMES) applied concurrently with compression therapy to improve muscle pump function and enhance fluid mobilization

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 fundamental aspect of physiotherapy, vital for managing edema and venous insufficiency. Various types and techniques exist, each with specific applications and considerations. While effective, improper application by untrained clinicians can pose risks, emphasizing the importance of safety measures and expertise. Future advancements hold promise for improved outcomes and accessibility. Overall, compression bandaging remains indispensable in enhancing patient care and quality of life.