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Influence of elastic bandage on knee pain, proprioception, and postural sway in subjects with knee osteoarthritis.

OBJECTIVES: To investigate whether a "standard" sized (that is, a size that would be prescribed by a physiotherapist) elastic bandage (S-bandage) around the knee of subjects with knee osteoarthritis (OA) would, in the short term (a) reduce pain, (b) improve knee joint proprioception, and (c) decrease sway in comparison with a looser (L-bandage). METHODS: In a cross over, within-subject study, 68 subjects (49 women, 19 men; mean age 67.1, range 36-87) with symptomatic and radiographic knee OA were randomly assigned to either an S-bandage or an L-bandage. Two weeks later they were assigned to the opposite bandage size. Knee pain (10 cm visual analogue scale (VAS)), knee proprioception, and static postural sway were assessed for each bandage two weeks apart. During each visit assessments were performed at baseline, after 20 minutes of bandage application, and immediately after bandage removal. RESULTS: The S-bandage did not have any effect on knee pain, proprioception, or postural sway. The L-bandage reduced knee pain significantly (pre-bandage application: median VAS 4.36, IQR 3.84 -4.90; after 20 minutes of bandage application: median VAS 3.80, IQR 3.3-4.3, p<0.001), improved static postural sway (pre-bandage: median sway 4.50, IQ range 3.5-6.4; bandage applied: median sway 4.45, IQ range 3.4-6.3, p=0.027), but had no significant influence on knee proprioception. CONCLUSIONS: In subjects with knee OA application of an elastic bandage around the knee can reduce knee pain and improve static postural sway. This outcome depends on the size of applied bandage.

Adult↗

A comparison of multilayer bandage systems during rest, exercise, and over 2 days of wear time.

OBJECTIVE: To study the interface pressure between the leg and 8 different multilayer bandage systems during postural changes, exercise (walking), and over 2 days of wear time. DESIGN: Comparison of 8 different compression bandages under standardized conditions. SETTING: Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland. PARTICIPANTS: A series of 10 healthy volunteers, 5 females and 5 males, aged 26 to 65 years. INTERVENTION: An electropneumatic device was used to measure interface pressure at 12 points of the leg. MAIN OUTCOME MEASURES: (1) Pressure changes from the standing to the sitting and supine position at rest, (2) pressure amplitude during exercise (200-m treadmill walk at 3.2 m/s, 0 degrees incline), and (3) pressure decrease over 2 days of wear time. RESULTS: Results are given as median with the 10% to 90% confidence intervals. Multilayer bandages of short and medium stretch showed a larger pressure decrease when the patient was supine (eg, 3 short stretch bandages: 18.0 mm Hg [reference range, 15.5-19.5 mm Hg]) than systems of medium and long stretch bandages (eg, 4-layer bandage, 6.0 mm Hg [reference range, 4.5-7.0 mm Hg]) (P=.005). The amplitude of pressure waves during exercise was comparable among most multilayer bandage systems. The pressure loss over time was the smallest in elastic bandages (eg, 4-layer bandage, 6.0 mm Hg [reference range, 0.0-10.5 mm Hg]), compared with short stretch bandages (eg, 3 short stretch bandages, 18.0 mm Hg [reference range, 16.5-20.5 mm Hg]) (P=.005). CONCLUSIONS: Highly elastic multilayer bandage systems showed the smallest pressure loss over several days, but the small pressure decrease when the patient was supine makes them potentially hazardous to patients with arterial occlusive disease. Short stretch bandages and the Unna boot with an inelastic zinc plaster bandage generate large pressure waves while walking and showed a marked pressure decrease when the patient was supine, but they lose a lot of their pressure within the first hours of wear. Multilayer systems composed of short stretch and cohesive medium stretch bandages represent a good compromise between elastic and inelastic bandage systems (moderate pressure loss over time, large pressure decrease on lying down). The clinical effectiveness of the different types of compression still remains to be studied.

Adult↗

Compression bandages and stockings for venous leg ulcers.

OBJECTIVES: To assess the effectiveness and cost-effectiveness of compression bandaging and stockings in the treatment of venous leg ulcers. SEARCH STRATEGY: Searches of 19 databases, hand searching of journals, conference proceedings and bibliographies. Manufacturers of compression bandages and stockings and an Advisory Panel were contacted for unpublished studies. SELECTION CRITERIA: Trials that evaluated compression bandaging or stockings, as a treatment for venous leg ulcers. There was no restriction on date or language. Ulcer healing was the primary endpoint. DATA COLLECTION AND ANALYSIS: Details of eligible studies were extracted and summarised using a data extraction sheet. Data extraction was verified by two reviewers independently. MAIN RESULTS: Twenty two trials reporting 24 comparisons were identified. Compression was more effective than no compression (4/6 trials). When multi-layered systems were compared, elastic compression was more effective than non-elastic compression (5 trials). There was no difference in healing rates between 4-layer bandaging and other high compression multi-layered systems (3 trials). There was no difference in healing rates between elastomeric multi-layered systems (4 trials). Multi-layered high compression was more effective than single layer compression (4 trials). Compression stockings were evaluated in two trials. One found a high compression stocking plus a thrombo stocking to be more effective than a short stretch bandage. The second small trial reported no difference between the compression stockings and Unna's boot. There was insufficient data to draw conclusion about the relative cost-effectiveness of different regimens. REVIEWER'S CONCLUSIONS: Compression increases ulcer healing rates compared with no compression. Multi-layered systems are more effective than single-layered systems. High compression is more effective than low compression but there are no clear differences in the effectiveness of different types of high compression.

Bandages↗

Bandages and topical agents.

Bandages are included in the regimen of therapy of superficial wounds. Bandages have varying functions depending upon the type of wound to which they are applied. When bandaging recently inflicted open wounds, the primary bandage layer may be dry-to-dry, wet-to-dry, or wet-to-wet, depending upon the type of tissue and exudate present on the wound. These bandages aid in debriding and cleansing a wound. The secondary layer of such bandages serves primarily to absorb material from the wound, and the tertiary bandage layer serves to hold the other bandage layers in place. Once an open wound is well into the repair stage of healing, an occlusive bandage may be considered to help enhance epithelialization of the wound. Bandages for wounds associated with compound fractures must include some form of fixation for the fracture. Other types of bandages are designed to (1) cover closed wounds, (2) provide pressure over a wound, and (3) relieve pressure over wounds or impending wounds. Bandages for closed wounds provide protection and allow for absorption of exudate that may be present. Pressure bandages are used to control minor hemorrhage, edema, and excess granulation tissue. With impending decubital ulcers, actual decubital ulcers, or repaired decubital ulcers, it is necessary to have a bandage designed to relieve pressure over the lesion. Many substances have been described for topical application to wounds. This section presents information on some substances available to or commonly used by veterinarians. It includes information on the wound lavage solutions chlorhexidine diacetate, povidone-iodine, hydrogen peroxide, and sodium hypochlorite solutions. Topical antibacterial agents are used to help prevent wound infection. The triple antibiotics, silver sulfadiazine, nitrofurazones, and gentamicin sulfate are some commonly used antibacterial agents. Hydrophilic agents are used to diffuse fluids through the wound tissues to bathe the tissues from the inside. Dry starch copolymer flakes and dextran polymer beads are two substances that help bathe the wound with the body's own fluids. Other topical medications are used to selectively act upon various wound tissues and exudates to aid in cleansing the wound; these include organic acid preparations and enzymatic debriding agents. In addition, a live yeast-cell derivative has been described for enhancing tissue oxygen consumption, epithelialization, and collagen synthesis in wounds.

Administration, Topical↗

Randomized trial of four-layer and two-layer bandage systems in the management of chronic venous ulceration.

To compare a four-layer bandage system with a two-layer system in the management of chronic venous leg ulceration, a prospective randomized open parallel groups trial was undertaken. In total, 112 patients newly presenting to leg ulcer services with chronic leg ulceration, screened to exclude the presence of arterial disease (ankle brachial pressure index <0.8) and causes of ulceration other than venous disease, were entered into the trial. Patients were randomized to receive either four-layer (Profore) or two-layer (Surepress) high-compression elastic bandage systems. In all, 109 out of 112 patients had at least one follow-up. After 24 weeks, 50 out of 57 (88%) patients randomized to the four-layer bandage system with follow-up had ulcer closure (full epithelialization) compared with 40 out of 52 (77%) on the two-layer bandage, hazard ratio = 1.18 (95% confidence interval 0.69-2.02), p = 0.55. After 12 weeks, 40 out of 57 (70%) patients randomized to the four-layer bandage system with follow-up had ulcer closure compared with 30 out of 52 (58%) on the two-layer bandage, odds ratio = 4.23 (95% confidence interval 1.29-13.86), p = 0.02. Withdrawal rates were significantly greater on the two-layer bandage (30 out of 54; 56%) compared with the four-layer bandage system (8 out of 58; 14%), p < 0.001, and the number of patients with at least one device-related adverse incident was significantly greater on the two-layer bandaging system (15 out of 54; 28%) compared with four-layer bandaging (5 out of 54; 9%), p = 0.01. The higher mean cost of treatment in the two-layer bandaging system arm over 24 weeks ($1374 [ pound 916] vs. $1314 [ pound 876]) was explained by the increased mean number of bandage changes (1.5 vs. 1.1 per week) with the two-layer system. In conclusion, the four-layer bandage offers advantages over the two-layer bandage in terms of reduced withdrawal from treatment, fewer adverse incidents, and lower treatment cost.

Aged↗

Multi-layer compression: comparison of four different four-layer bandage systems applied to the leg.

OBJECTIVE: To compare performance of four commercial four-layer bandage systems when applied to the leg. METHODS: Four experienced bandagers applied each system: [Profore Regular (Smith and Nephew); Ultra-Four (Robinson); System 4 (Seton) and K Four (Parema)] to the same leg. Bandages were applied as single layers and as completed systems using standard techniques. For each application, 18 pressure measurements were taken using the Borgnis Medical Stocking Tester (MST) at three measuring points (ankle, gaiter and mid-calf) on medial and lateral aspects in three postures: (horizontal, standing and sitting). RESULTS: In all 2304 observations were made, 576 for each bandager, 576 for each bandaging system, 768 for each measuring point, 1152 for each aspect and 768 for each posture. The increase in pressure produced by each additional layer was 65-75% of the pressure of the same bandage when used as a single layer. There were significant differences in the final pressures achieved by the bandagers (means: 45-54 mmHg, p<0.001) and between bandage systems (means: System 4: 46 mmHg, Profore: 47 mmHg, K Four: 52 mmHg, Ultra-Four: 54 mmHg; p=0.005). The relationships between the final pressures achieved at each of the three measuring points, the three postures and the two aspects were not consistent among the bandage systems (p<0.01). CONCLUSIONS: When a bandage is applied as part of a multi-layered system it exerts approximately 70% of the pressure exerted when applied alone, thus challenging the commonly-held assumption that the final pressure achieved by a multi-layer bandaging system is the sum of the pressures exerted by each individual layer. Each of the four bandaging systems exerted different final pressures and gradients and different changes with posture change. These differences have important implications, which could influence the selection (or avoidance) of a particular bandage system according to a patient's condition and circumstances.

Bandages↗

Inelastic leg compression is more effective to reduce deep venous refluxes than elastic bandages.

BACKGROUND: Deep venous refluxes play an important triggering role for the development of venous leg ulcers. Compression therapy is able to reduce these refluxes depending on pressure and the kind of material being used. OBJECTIVE: To compare the efficacy of compression bandages of varying pressure and material (elastic, long-stretch versus inelastic, short-stretch bandages, four-layer bandages). METHODS: Venous volume (VV) and venous filling index (VFI) as a quantitative parameter of venous reflux were measured using an airplethysmograph (APG) in a total of 21 patients presenting with venous leg ulcers and deep venous refluxes. Bandage pressure was measured in every experiment. The influence of elastic and inelastic bandages with increasing pressure and the changes in these parameters using different bandages with the same pressure were investigated. RESULTS: The initial median value of VFI without compression was 8.45 ml/sec. VV and VFI were significantly reduced by increasing external pressure, more strongly with inelastic than with elastic material. With a pressure of 25 mmHg inelastic bandages diminished VFI to a median of 3.25 ml/sec while the elastic material did not even approach this value with a pressure of 40 mmHg (4.25 ml/sec). Applying bandages of different material with the same pressure of 30 mmHg, the most intense reduction of VV and VFI was obtained by inelastic and by four-layer bandages. The effect on venous reflux was statistically significantly superior with inelastic compared to elastic material. CONCLUSION: Using the same bandage pressure, inelastic material is more effective at reducing deep venous refluxes than elastic bandages in patients with venous ulcers. Four-layer bandages show similar efficacy to inelastic bandages.

Adult↗

Bandaging in the treatment of venous ulcers: a European view.

The principal treatment of venous ulcers in ambulatory patients in bandaging. The physiological rationale for this treatment is to improve the venous hemodynamic abnormality caused by prolonged venous hypertension due to limb venous valvular incompetency. Correct bandaging results in the reduction of limb edema and ulcer healing. A number of different bandages and combined bandaging regimens are used in the treatment of venous ulceration. Recently the European Tissue Repair Society has defined different types of bandages based on their function into four groups: (1) Extensible bandage; (2) Elastic bandage; (3) Compression bandage; and (4) Support bandage. The ability of a bandage to produce a gradient compression starting at 35 to 45 mmHG at the ankle and reducing as the bandage approaches the knee is stated in the literature as a goal of bandaging. Our studies and others have shown that routine measurements of limb circumference as an indicator of edema reduction is another way of monitoring the efficacy of the results of bandaging since edema reduction and control is associated with improved ulcer healing.

Bandages↗

The RDH bandage: hemostasis and survival in a lethal aortotomy hemorrhage model.

BACKGROUND: The Rapid Deployment Hemostat (RDH) Bandage has been designed in collaboration with the Office of Naval Research for the treatment of bleeding because of extremity trauma. It is intended as both a battlefield and civilian severe trauma wound dressing. It consists of a specific formulation of Marine Polymer Technologies' proprietary hemostatic polymer poly-N-acetyl glucosamine, and has received FDA clearance. This study compares the hemostatic capabilities of the RDH Bandage with the standard U.S Army First Aid Field Bandage (AFAFB), utilizing a controlled lethal aortotomy model of hemorrhage. MATERIALS AND METHODS: Aortic punch wounds 4 mm in diameter were made in the abdominal aortas of female Yorkshire White swine, and were allowed to bleed for 5 s before application of test materials. Test hemostats were applied to the wound with manual compression for 10 min. Total loss of blood was determined in each experiment. Bandages were removed at the end of 2 h, for those animals that survived, and the onset of re-bleeding was observed. Animals were monitored for an additional 30 min to assess survival following bandage removal. Hemostatic efficacy was judged by the total loss of blood, and the survival of the animals. RESULTS: Eighty percent of the animals treated with the RDH Bandage survived the study through the entire protocol, whereas only 40% of those treated with the Army First Aid Field Bandage survived the removal of manual compression step, and none survived following the removal of bandage after the 2 h observation/monitoring period. The average blood loss for the RDH Bandage treated animals was 234 ml, and the average blood loss for the Army First Aid Field Bandage treated animals was 1071 ml, through the observation/monitoring period. CONCLUSIONS: The RDH Bandage is significantly superior to the standard issue U.S. Army First Aid Field Bandage in the control of hemorrhage in a lethal swine abdominal aortotomy hemorrhage model, resulting in decreased blood loss and increased survival.

Animals↗

Optimal bandaging of smallpox vaccination sites to decrease the potential for secondary vaccinia transmission without impairing lesion healing.

OBJECTIVE: To assess the optimal method for covering smallpox vaccination sites to prevent transmission of vaccinia. DESIGN: Randomized, nonblinded clinical trial. SETTING: Tertiary care medical center. PARTICIPANTS: Vaccinia-naive and vaccinia-experienced volunteers. INTERVENTIONS: After vaccination, study participants were randomized to receive 1 of 3 types of bandage: gauze, occlusive with gauze lining, or foam. Vaccination sites were assessed every 3 to 5 days until the lesion healed. During each visit, specimens were obtained from the vaccination site, the bandage surface before removal, and the index finger contralateral to the vaccination site and were cultured for vaccinia. Time to lesion healing was assessed. RESULTS: All 48 vaccinia-naive and 47 (87%) of 54 vaccinia-experienced participants developed a vesicle or pustule at the injection site 6-11 days after vaccination. Fourteen (14%) of 102 participants had bandage cultures positive for vaccinia. All but 1 of these vaccinia-positive cultures were of a bandage from participants randomized to the gauze bandage group, and all but 3 were of bandages from vaccinia-naive participants. No finger-specimen cultures were positive for vaccinia. One episode of neck autoinoculation occurred in a vaccinia-naive individual who had vaccinia recovered from his gauze bandage on multiple visits. The foam bandage was associated with more local adverse effects (skin irritation and induration). The time to healing did not differ among the bandage groups. CONCLUSIONS: The potential for transmission of vaccinia from a vaccination site is greater if the site is covered by gauze than if it is covered by occlusive or foam bandages. Use of an occlusive bandage with a gauze lining is the best choice for coverage of smallpox vaccination sites because of a reduced potential for vaccinia transmission and a lower reactogenicity rate. Bandage choice did not affect vaccination lesion healing.

Adult↗

Mechanics of knee and ankle bandages.

Different types of bandages were tested mechanically and clinically. Four elastic and three elastic adhesive bandages were mechanically tested. The former proved better. Seven different ankle bandages and three knee bandages were tested in a simulated clinical situation, measuring the pressure which developed while walking for 15, 50 and 100 min, and immediately after application of the bandage. The bandages slackened most markedly during the first period of walking. The compression pressure of the padded adhesive ankle bandage was lower than that produced by most other bandages. The padded adhesive and elastic bandages proved to be most suitable for clinical use. The padded knee bandage produced a lower compression load than the elastic bandage tested. On the basis of this trial we recommend the use of a padded knee bandage.

Ankle↗

The use of pressure change on standing as a surrogate measure of the stiffness of a compression bandage.

OBJECTIVES: To measure interface pressure and stiffness of short-stretch and long-stretch bandages applied with variable strength. These parameters have a deciding influence on the efficacy of compression therapy in chronic venous disease. DESIGN: Prospective experimental study. MATERIALS AND METHODS: Compression bandages constructed of different materials were applied with light, moderate and high pressure. Interface pressure was measured over the medial aspect of leg in 12 healthy individuals. Long-stretch bandages were compared to short-stretch bandages. The difference between standing and supine pressure was used to characterise stiffness. RESULTS: In the low pressure range the median pressure of the final bandage in the supine position was between 18 and 30 mmHg for the long-stretch and 25-33.5 mmHg for the short-stretch bandages (p<0.01, Mann-Whitney U-test). The median differences between standing and supine pressure were between 2.0 and 8.5 for the long-stretch and 6.0-10.5 mmHg for the short-stretch material. In the group of moderate pressure the median values in the supine position were in a range 33.0-58.0 mmHg, for long-stretch and 39.0-49.5 mmHg for short-stretch bandages, with an increase after standing of 6.0-7.0 mmHg with long-stretch, and 14.0-21.0 mmHg with short-stretch bandages (p<0.01, Mann-Whitney U-test). The median supine pressure values in the high pressure group were between 52.0 and 67.0 mmHg for long-stretch and 59.5-67.0 mmHg for short-stretch material. The median increase during standing ranged between 8.5 and 14.5 mmHg in the elastic group and 23.0-33.0 in the inelastic group (p<0.01, Mann-Whitney U-test). CONCLUSION: A bandage applied with light pressure corresponds to the moderate pressure category of stockings. The difference between the sub-bandage pressure from supine to standing can be used to characterise the stiffness of a bandage.

Adult↗

Bandaging technique after knee replacement.

BACKGROUND: Firm bandaging of the knee following knee replacement may prevent bleeding into the joint by a tamponade effect. We studied the pressure required to achieve tamponade, and then clinically compared the use of a compression bandage with the use of a standard crêpe bandage, with or without a drain. METHOD: Transducers were used to measure the pressure achieved on the surface of the knee under different bandages, and within the knee following release of the tourniquet. We prospectively compared 3 series of 50 patients each: (1) with compression bandaging from toes to mid-thigh, (2) with crêpe bandage from mid-calf to mid-thigh alone, or (3) with crêpe bandage and suction drain. RESULTS: The pressure within the joint at which tamponade occurs is 52-62 mm Hg. The pressure on the skin under a properly applied compression bandage is between 28 and 32 mm Hg, and this controls bleeding within the joint. Patients treated with compression bandaging recovered more quickly from the operation, had a shorter hospital stay, and a greater range of flexion on discharge. They had no swelling of the limb, rarely suffered a tense hemarthrosis, and had fewer complications. INTERPRETATION: The use of a compression bandage incorporating the foot and calf following knee replacement surgery, without the use of drains, confers specific advantages over the use of a crêpe bandage alone.

Aged↗

The effect of elastic bandages on human knee proprioception in the uninjured population.

Elastic bandages are often used to treat musculoskeletal disorders, even though there is little scientific evidence currently to support this generalized practice. We tested the hypothesis that elastic bandages improve proprioception of the bandaged joint during their use, and that this benefit was more than temporary. The uninjured human knee was used as a model. Fifty-four volunteers (54 knees), aged 22 to 40 years, were asked to identify a prior set joint angle as their knee was passively extended. Each knee was tested without the elastic bandage, immediately after bandage application, after 1 hour of bandage wear, and finally after removal of the bandage. Results showed that elastic bandages significantly improved knee joint proprioception in the uninjured knee during the entire interval of their use (mean decrease in inaccuracy of 1.0 degree, equivalent to 25% improvement, P < 0.05), and that this benefit was lost when the bandage was removed. The magnitude of the improvement, or the potential beneficial effect of the bandage, was inversely related to the participant's inherent knee proprioceptive ability, which was demonstrated in the test group before the initial application of the bandage.

Adult↗

Evaluation of the Esmark bandage as a tourniquet for forefoot surgery.

PURPOSE: Although used routinely as a tourniquet in forefoot surgery, the pressure under an Esmark bandage has had little evaluation, and its use has been discouraged by some. The purpose of this study was to quantitate the pressure generated by an elastic bandage in a clinical setting and compare several different types of commercially available Esmark bandages. METHODS: Five foot and ankle fellowship program directors and five foot and ankle fellowship trained surgeons comprised the volunteer group which performed clinical simulations with a 6-inch Esmark bandage at the ankle level. Variables were then added, including different padding, a change in the position of the surgeon, and a 4-inch Esmark bandage. A questionnaire on their use of an elastic bandage in practice was also administered. Differences in pressure between different types of available 6-inch Esmark bandages were also compared. Pressure measurements were recorded by a pressure monitor device. RESULTS: The average pressure of the 10 surgeons' trials for three wraps with a tuck was 222 mm Hg (range, 146-319 mm Hg); four wraps with a tuck averaged 288 mm Hg (range, 202-405 mm Hg). No significant difference was seen between the standard technique and when the surgeon stood (three wraps and a tuck, p =.26; four wraps and a tuck, p =.33), when cast padding was used (three wraps and a tuck, p =.62; four wraps and a tuck, p =.74), or a 4-inch Esmark bandage (three wraps and a tuck, p >.99; four wraps and a tuck, p =.34). There was a significant decrease in the pressure when a blue towel was used as padding (three wraps and a tuck, p =.05; four wraps and a tuck, p =.04). Pressures obtained by the 10 different volunteers were uniform with little variation (three wraps and a tuck = 222 +/- 61 mm Hg; four wraps and a tuck = 288 +/- 68 mm Hg). No significant difference was seen between the different types of 6-inch Esmark bandages (p >.05). The combined complication rate for the 10 surgeons is estimated to be less than 0.1%. CONCLUSION: The practice of using a 6-inch Esmark bandage as a tourniquet at the ankle level for forefoot procedures is a safe and reliable method. Although pressures between surgeons vary, the average pressure is in an effective yet safe range. Recommendations for the application of the Esmark bandage as a tourniquet are given.

Ankle↗

Design and development of novel bandages for compression therapy.

During the past few years there have been increasing concerns relating to the performance of bandages, especially their pressure distribution properties for the treatment of venous leg ulcers. This is because compression therapy is a complex system and requires two or multi-layer bandages, and the performance properties of each layer differs from other layers. The widely accepted sustained graduated compression mainly depends on the uniform pressure distribution of different layers of bandages, in which textile fibres and bandage structures play a major role. This article examines how the fibres, fibre blends and structures influence the absorption and pressure distribution properties of bandages. It is hoped that the research findings will help medical professionals, especially nurses, to gain an insight into the development of bandages. A total of 12 padding bandages have been produced using various fibres and fibre blends. A new technique that would facilitate good resilience and cushioning properties, higher and more uniform pressure distribution and enhanced water absorption and retention was adopted during the production. It has been found that the properties of developed padding bandages, which include uniform pressure distribution around the leg, are superior to existing commercial bandages and possess a number of additional properties required to meet the criteria stipulated for an ideal padding bandage. Results have indicated that none of the mostly used commercial padding bandages provide the required uniform pressure distribution around the limb.

Bandages↗

[Comparison between the efficacies of two different methods of preparing Esmarch bandages for sterilization].

OBJECTIVES: Sterile Esmarch bandages have a widespread use in orthopedic surgery. We evaluated the efficacy of two different methods of preparing Esmarch bandages for sterilization. METHODS: Two groups of Esmarch bandages were used, each group consisting of 25 bandages. The size of the bandages was 6.3 cm in width and 450 cm in length. Before sterilization, the bandages were tightly rolled in one group and loosely folded at a length of 10 cm in the other. An indicator was inserted at every five layers of all bandages. Sterilization was evaluated by subjecting both groups to ethylene oxide cycles and the autoclave method. A standard orthopedic surgical set was used as a control during each sterilization. RESULTS: Following sterilization with ethylene oxide, all the indicators were found sterile in both groups. Similarly, complete sterilization was obtained in the loosely folded bandages with the autoclave method. However, only the indicators placed in the first 15 layers and the fiftieth layer were fully sterile in the tightly rolled bandages after autoclaving. The number of sterile indicators in the remaining layers ranged from nine (36%) to 23 (92%). CONCLUSION: Ethylene oxide is a reliable technique for sterilizing Esmarch bandages. The bandages must be loosely folded, instead of tightly rolling, when the autoclave technique is used.

Bandages↗

Comparison in the interface pressure under self-adherent and non-self-adherent bandages during standing and exercise.

BACKGROUND: Self-adherent bandages are useful to prevent the bandage from becoming loose. However, the material binds tightly to itself to form a tight band, which may result in changes in interface pressure under the bandages during changes in posture and exercise, because the pressure depends on the elasticity of the bandages. The aim of this study was to compare the interface pressures under self-adherent and non-self adherent bandages while standing and during exercise. PATIENTS AND METHODS: In 20 normal volunteers the pressure was determined at the posteromedial area of the midcalf during lying, standing, tip-toe exercise and walking, using an Air Pack Type Analyzer. We examined two kinds of bandages with a maximal tension of 70%, self-adherent and non-self-adherent bandages. RESULTS: There was no significant increase in pressure observed during standing in comparison with pressure in the supine position immediately after application. A significant increase in pressure under both bandages was observed during tip-toe exercise and walking. However, there was no significant difference in pressure during standing or exercise between self-adherent and non-self-adherent bandages. Furthermore, there was no significant pressure difference between muscle contraction and relaxation between the two bandages. CONCLUSION: Self-adherent bandages can maintain their own elasticity, even when the material binds tightly to itself.

Adult↗