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PubMed2004

VenUS I: a randomised controlled trial of two types of bandage for treating venous leg ulcers.

OBJECTIVES: To compare the clinical and cost-effectiveness of two different compression bandages for the healing of venous leg ulcers. DESIGN: A pragmatic, randomised controlled trial with an economic evaluation. SETTING: Community, district nurse-led services; community leg ulcer clinics; hospital leg ulcer clinics with community outreach. A range of urban and rural settings in England and Scotland. PARTICIPANTS: Patients with a venous leg ulcer of at least 1-week's duration, at least 1 cm in length or width and an ankle:brachial pressure index of at least 0.8. INTERVENTIONS: The four-layer bandage (4LB) (which is multilayer elastic compression) compared with the short-stretch bandage (SSB) (multilayer, inelastic compression). MAIN OUTCOME MEASURES: The primary end-point was complete healing of all the ulcers on the trial leg. Secondary outcomes were the proportion of patients healed at 12 and 24 weeks, rate of recurrence, costs of leg ulcer treatment and quality of life. RESULTS: Between April 1999 and December 2000 the trial recruited 387 people aged from 23 to 97 years at trial entry. The majority of patients in this trial (82%; 316/387) had a reference ulcer of area </=10 cm(2). To test the difference over time of Kaplan--Meier curves for the two bandage groups, the distribution of the cumulative times to healing of individuals in the two trial groups was compared using the log-rank test. The difference in the distribution of cumulative healing times between the individuals in the two groups was not statistically significant at the 5% level. Adjusting for the effects of variables which may influence healing (centre, baseline ulcer area, duration, episodes, ankle mobility, weight) in a Cox proportional hazards model, a statistically significant treatment effect in favour of the 4LB was identified. At any point in time, the probability of healing for individuals in the SSB treatment arm is significantly lower than that for people treated with the 4LB. Our base case economic analysis showed that the 4LB is the dominant strategy, that is, it is associated with a greater health benefit and lower costs than the SSB, although the differences are not statistically significant. This result is explained largely by the greater number of community nurse visits required by participants in the short-stretch arm. CONCLUSIONS: The 4LB, which is currently the UK standard compression bandage for people with venous leg ulcers, was more clinically and cost-effective than the SSB. The bandage costs were less important than the costs of treatment visits, and patients in SSBs required more treatment overall. Generally, this trial supports the use of the 4LB in preference to the SSB. Recommendations for future research include: exploration of the relationship between bandager skill, application technique and ulcer healing; the relative cost-effectiveness of community leg ulcer clinics; and the study of nurse decision-making in venous ulcer management.

Adult↗
PubMedDate not supplied

Physical properties of short-stretch compression bandages used to treat lymphedema.

This study examined the physical properties of six common brands of short-stretch compression bandages used to treat lymphedema. The physical properties examined were (a) maintenance of pressure over a 12-hr period, (b) variability of pressure across the width of the bandages, and (c) variability of pressure when the bandages were wrapped with a 50% overlap. The results of the study indicate that all six brands of bandages tested maintain pressure well over a 12-hr period. Each has a variance of pressure between the middle and edge of the bandage, with the edges measuring (in mmHg) between 6% and 28% lower than the middle. When the bandages were wrapped with an 50% overlap, all six brands measured fairly consistently in pressure readings (in mmHg) across the width. These results indicate that the six brands of short-stretch compression bandages tested have similar physical characteristics.

Bandages↗
PubMed2002

[Heel pressure ulcers. Comparative study between heel protective bandage and hydrocellular dressing with special form for the heel].

INTRODUCTION: The heels, together with the sacra area, are one of the most frequent spots where pressure sores appear here in Spain. Any preventive measure against pressure sores on heels needs be oriented towards two main objectives: effective relief of pressure and its compatibility with localized care and skin inspection in order to detect lesions early on at least once a day. PATIENTS, MATERIALS AND METHODS: The authors planned a comparative, multi-centered, open, labeled and controlled study in which patients were assigned to two groups receiving these treatments: one received traditional preventive pressure sore treatment and a protective bandage on their heels while the other used a special Allevyn Heel hydrocellular dressing to protect their heels. The patients took part in this study over an eight week period. The response variable used to determine the effectiveness of the preventive measure in this study was the appearance of pressure sores. RESULTS: At the beginning, 130 patients were included in this study, 65 in each one of the treatment groups. In the bandage group, 50 patients finished this study while 61 in the dressing group finished this study. The appearance of pressure sores in the protective bandage group occurred in 44% of the patients, 22 out of 50, while in the dressing group, the occurrence rate was 3.3%, 2 out of 61 patients with a value of "ji" squared p < 0.001. The risk factor to develop a pressure sore brought us a value of relative risk of 13.42 (IC 95%: 3.31-54.3) in the group wearing the protective bandage compared to the group wearing the dressing. COMMENTS: The results of this study allow us to accept as valid the alternate hypothesis that there exist significant statistical differences between both treatment methods in favor of the Allevyn Heel dressing instead of the protective heel bandage. The use of this dressing, even though it is more expensive a priori than the protective bandage, in terms of unit cost for the product, has proven to be more effective in preventing pressure sores, and cheaper than the protective bandage if we bear in mind these combination of variables: time of usage, application and removal.

Bandages↗
PubMedDate not supplied

[Elastic compression by calibrated bandage].

Elastic compression using the interchangeable bandage is still one of the best treatments of uncompensated venous deficiency, which has reached the complications stage. Of the three parameters necessary to the proper use of this treatment, only the strength of the bandages and the number of turns or overlaps used to be accessible. Today, the Thuasne Firm has achieved a gauge of the bandage using an original printing method, which involves drawing out 30% of this bandage by showing squared geometric figures, concealed, clearly, by an overlap of 2/3 or 3/4. In this way, for the "light" bandage of the category Biflex 16, a pressure-bracket of 15-30 mm Hg is obtained, and for a "heavy" bandage, Biflex 17, pressures ranging from 35-80 mm Hg. Thus, the empiricism always in mind when interchangeable bandages were the issue, ought from now on to make way for a more rigorous approach, interchangeable compression becoming constant, easily reproduced, and easily manageable.

Bandages↗
PubMed1976

[Development and application of a new polyurethane plastics support bandage (author's transl)].

Experiences with a newly developed plastics support bandage on 1007 patients are reported. A polyurethane hard foam composition developed specially for medical purposes was used, which is created by blending the two components A (polyol) and B (isocyanate). The principle of our support bandage lies in the fact that after being mixed in a 1:1 ratio, the two highly viscous components are packed into a cotton stocking having a high transverse elasticity. After being rolled out to the desired thickness, the stocking is wrapped around the extremity which it is to support, where it hardens out into a polyurethane hard foam composition. By reason of the moisture content of the scoured cotton stocking, a 1 to 2 mm thick layer of foam forms in the contact region and renders any further padding unnecessary. Correspondingly, by using a double chamber stocking, circular bandages have been produced which can be removed, by means of incorporated zip and interengaging hook fasteners. Reclining shells, abduction bandages and body corsets can be made in the same way. The physical properties of the support bandage are illustrated: apart from its low weight, the bandage is particularly advantageous by reason of its high strength, insensitivity to water and ideal permeability to X-rays. The support bandages are easily made up and entail negligible cost.

Braces↗
PubMed2003

Randomized clinical trial and economic analysis of four-layer compression bandaging for venous ulcers.

BACKGROUND: The aim of this study was to compare the cost-effectiveness of four-layer compression bandaging for venous leg ulcers with that of other available treatments. METHODS: In this pragmatic trial, 200 patients with a venous leg ulcer were randomized either to four-layer bandaging (intervention group; n = 100) or to continue their usual system of care (control group; n = 100). The follow-up for each patient was 12 weeks. Analysis was by intention to treat; the main outcome measures were time to healing and cost to the health board per leg healed. RESULTS: Baseline characteristics were well matched in the two groups. The Kaplan-Meier estimate of the healing rate at 3 months was 54 per cent with four-layer bandaging and 34 per cent in the control group. Throughout the 3 months, four-layer bandaging healed leg ulcers significantly earlier (P = 0.006). There was a significant reduction in the median cost per leg healed with four-layer bandaging (euro 210 versus euro 234; P = 0.040). CONCLUSION: Four-layer bandaging is currently the most effective method of treating venous leg ulcers in a community setting.

Aged↗
PubMed2003

Randomized clinical trial of three-layer paste and four-layer bandages for venous leg ulcers.

BACKGROUND: Both four-layer and three-layer paste bandages are widely used in the treatment of venous leg ulcers. The aim of this study was to compare the efficacy of these two bandaging regimens. METHODS: The study was a prospective, randomized, open comparison of a consecutive cohort of 133 patients with venous ulcers. Participants were stratified by ulcer size into one of three groups and were randomized within each group to receive either three-layer paste or four-layer bandages. All patients were followed for 1 year. The time taken to complete ulcer healing was the primary endpoint. The time taken to apply the bandages, comfort, tolerability and cost were also assessed. Analysis was performed on the basis of intention to treat. RESULTS: Ulcers healed completely in 51 (80 per cent) of 64 patients treated with three-layer paste bandages compared with 45 (65 per cent) of 69 patients treated with the four-layer regimen (P = 0.031). This difference developed only after 20 weeks of treatment. The median times to complete healing were 12 weeks for three-layer and 16 weeks for four-layer treatment (P = 0.040). Results of venous function tests, including half-refilling times, were similar in the two groups. CONCLUSION: Three-layer paste bandages were significantly more effective at healing venous ulcers than the four-layer regimen in this study.

Aged↗
PubMed2005

Pressure-immobilization bandages delay toxicity in a porcine model of eastern coral snake (Micrurus fulvius fulvius) envenomation.

STUDY OBJECTIVES: Pressure-immobilization bandages are used in countries where neurotoxic snake envenomations are common. They impede lymphatic egress from the bite site and delay systemic venom toxicity. The effectiveness of these devices has not been evaluated in coral snake envenomations. We investigated the efficacy of pressure-immobilization bandages in delaying the onset of systemic toxicity in a porcine model of coral snake envenomation. METHODS: A randomized controlled trial of pressure-immobilization bandages was conducted in a university animal care center. Subjects were 12 anesthetized, spontaneously breathing pigs, ranging from 9.1 to 11.4 kg. After injection with 10 mg of Micrurus fulvius fulvius venom in the subcutaneous tissue of the distal foreleg, subjects were randomized to receive no treatment or application of a pressure-immobilization bandage at 1 minute after injection. Treated animals had elastic bandages applied to the extremity and splinting for immobilization. Vital signs and quality of respirations were recorded. Outcome was the onset of respiratory failure or survival to 8 hours. Necropsies and histologic analysis of the envenomation site was performed. RESULTS: One animal from each group was removed because of the discovery of pre-existing respiratory pathology. Four of 5 pigs in the treatment group survived to 8 hours, but none in the control group survived. Mean time to onset of respiratory compromise was 170.4 +/- 33.3 minutes in the control group. None of the pigs had histologic changes at the envenomation site consistent with ischemia or pressure-related injury. CONCLUSION: Pressure-immobilization bandages delayed the onset of systemic toxicity in our porcine model of M fulvius envenomation.

Animals↗
PubMed2006

Twenty-four hours or 10 days? A prospective randomised controlled trial in children comparing head bandages following pinnaplasty.

The perceived benefits of bandaging for 10 days following pinnaplasty have been questioned by previous studies. The problems arising from these dressings are many [Powell BWEM. The value of head dressings in the postoperative management of the prominent ear. Br J Plast Surg 1989;42:692-4. Bartley J. How long should ears be bandaged after otoplasty? J Laryngol Otol 1998;112:531-2. Wong MC, Sylaidis P. Head dressings for pinnaplasty: a tradition not supported by evidence. Br J Plast Surg 2001;54:81-2], including their slippage [Powell BWEM. The value of head dressings in the postoperative management of the prominent ear. Br J Plast Surg 1989;42:692-4. Bradbury ET, Hewison J, Timmons MJ. Psychological and social outcome of prominent ear correction in children. Br J Plast Surg 1992;45:97-100. Jeffery SLA. Complications following correction of prominent ears: an audit review of 122 cases. Br J Plast Surg 1999;52:588-90]. Eighty children were recruited into a prospective randomised controlled trial comparing the use of a head bandage for only 24 h with a standard practise of a 10-day head bandage. A preoperative measurement of the lateral ear projection (LEP) was made. The outcome measures recorded during the two planned postoperative visits at 10 days (visit 1) and 2 months (visit 2) were: patient satisfaction score, LEP, complications and any unscheduled hospital visits associated with the surgery. There was no significant difference in LEP and patient satisfaction between the two groups at both the scheduled postoperative visits. Differences between the groups in the number of unscheduled visits (p=0.21) did not reach statistical significance. The findings indicate that it is safe and effective to use head bandage for only 24 h following surgical correction of prominent ears. This study shows no benefit from the application of a formal head bandage for any longer than 1 day.

Adolescent↗
PubMed1991

A simple and effective method of sterilizing Esmarch bandages.

The authors evaluated three methods of sterilizing Esmarch bandages. A commercially available autoclave tape laid along the whole length of the midpoint of the width of the bandage was used to determine sterility. Satisfactory sterility was achieved by rolling the Esmarch loosely, with a standard crepe bandage interposed between layers. Tightly rolled bandages and folded bandages without the crepe bandage interposition could not be reliably sterilized.

Bandages↗
PubMed1997

Effects of compression bandaging on leg pulsatile blood flow.

Leg external compression bandaging is the mainstay of venous ulcer treatment, yet little is known about the impact of therapeutic compression levels on arterial haemodynamics. In this study, the effect of foot-to-knee, four-layer compression bandaging on below-knee arterial pulsatile blood flow was assessed by nuclear magnetic resonance flowmetry. In 14 healthy supine subjects bilateral flow measurements at five below-knee sites without compression, and after compressing one leg to an average malleolar sub-bandage pressure of 40.7 +/- 4.0 mmHg, revealed a potentially important new phenomenon. The forefoot-to-knee compression bandaging caused a highly significant (P < 0.001) increase in the bandaged leg pulsatile blood flow owing to increases in both peak flow and pulse width. It is hypothesized that arteriolar vasodilatation, induced either myogenically by reduced transmural pressure or by vasodilatory substance release triggered by increased venous shear stress, produce the observed compression-related phenomenon. Whatever the mechanism(s), the finding of a compression-associated pulsatile flow increase suggests a previously undiscovered arterial linkage, which may play a role in the well-documented beneficial effects of compression bandaging in venous ulcer treatment. A possible impact of the arterial flow-pulse increase is speculated to effect venous ulcer outcome via a decrease in leucocyte effects in the distal microvasculature, as a consequence of the more vigorous haemodynamic state.

Adult↗
PubMed2004

Randomized trial comparing vaccinia on the external surfaces of 3 conventional bandages applied to smallpox vaccination sites in primary vaccinees.

BACKGROUND: Concern about accidental contact transmission after smallpox vaccination has prompted various recommendations regarding vaccination site coverage. METHODS: On days 6-8 after their first-ever smallpox vaccination, 63 adult subjects were randomized to apply a self-adhesive bandage (n=20), gauze with adhesive tape (n=21), or gauze with a semipermeable dressing (n=22) over the vaccination site for a mean of 8+/-2 h. Swabs from the external bandage surfaces and the vaccination sites were then assessed by real time vaccinia-specific polymerase chain reaction (PCR) in blinded fashion. RESULTS: Among 58 subjects completing the study, PCR results were positive for the vaccination site in 55 (94.8%) and on 10 swabs (17.2%) from external bandage surfaces. There were no differences among the 3 bandages (P=.57). CONCLUSIONS: At 7 days after smallpox vaccination, a peak time for vaccinia shedding, a self-adhesive bandage was as effective as 2 bulkier, less convenient bandages in limiting PCR-detectable virus on the external surface.

Adult↗
PubMed2006

Radioactive skin bandages incorporating 32P for treatment of superficial tumors.

Radioactive bandages incorporating 32P, a high-energy beta- emitter, were prepared with an aim to have a radiation source that can be used for the treatment of superficial tumors. 32P-Chromic phosphate particles were prepared and filtered through Millipore filters. Filter incorporating 32P activity was immobilized between nitrocellulose membranes and placed on an adhesive bandage. There was no leakage of radioactivity from the bandage when tested in saline. Efficacy of the radioactive bandage for treatment of superficial tumors was tested in melanoma-bearing C57BL/6 mice. A single dose of treatment with 74 MBq 32P bandage resulted in tumor growth delay, whereas multiple dose treatment with 74 MBq 32P bandage at twice-weekly intervals resulted in complete tumor regression when treatment was started, when the tumor was merely palpable. Histology sections from the treated animals showed absence of tumor.

Administration, Topical↗
PubMedDate not supplied

Evaluation of cohesive and elastic support bandages for joint immobilization.

The purpose of this clinical study was to compare the performance of a new cohesive bandage to that of elastic bandages for joint immobilization. The magnitude of joint immobilization by these bandages was quantitated during isokinetic exercise using a computerized dynamometer. The degree to which the cohesive and elastic bandages reduced range of motion and peak torque of plantar and dorsiflexion was not significantly different. After exercising for 1 hour, the elastic bandage loosens, reducing its ability to immobilize the joint. In contrast, the cohesive bandage maintains its configuration, despite active exercise for 1 hour.

Adhesives↗
PubMed2000

When is reduced-compression bandaging safe and effective?

During a one-year period 44 patients were treated with reduced-compression bandaging in the vascular unit at a district general hospital. Twenty patients with venous ulcers were referred from community leg ulcer clinics because they could not tolerate standard compression bandaging (group 1). A further 24 patients had mixed aetiology leg ulcers (group 2), and high-compression bandaging was not attempted because of significant peripheral vascular disease (ankle brachial pressure index < 0.8). Forty-two patients tolerated reduced-compression bandaging without discomfort or skin pressure changes. Healing was achieved in 32 patients (13 in group 1 and 19 in group 2). All non-healed ulcers were considered smaller at the time of final follow-up, and had less exudate. Reduced-compression bandaging has been shown to be effective and well tolerated by patients with venous ulcers who cannot comply with high-compression bandaging. With close supervision, it is safe to use in patients with significant peripheral vascular disease.

Adult↗
PubMed2001

Treatment of grade 4 renal stab wounds with absorbable fibrin adhesive bandage in a porcine model.

PURPOSE: In a porcine model we evaluated the efficacy of the absorbable fibrin adhesive bandage and other novel fibrin products for treating major renal stab wounds. MATERIALS AND METHODS: In commercial swine we produced an almost lethal, grade 4 renal stab wound via a 3.5 cm. sagittal, centrally located, through-and-through laceration. Each pig then received treatment in random fashion, including conventional oversewing of capsular defects with absorbable gelatin sponge and horizontal mattress sutures in 6, external absorbable fibrin adhesive bandage that was pressure held for 60 seconds in 6, external and internal absorbable fibrin adhesive bandage that was applied externally, inserted into the renal defect and pressure held for 60 seconds in 6, liquid fibrin sealant that was placed in the laceration and held for 60 seconds in 8, fibrin foam that was applied in the same manner as liquid fibrin in 5 and closing of the peritoneum over the lacerated kidney without further treatment in 6. Blood loss and time to hemostasis were recorded. Animals were sacrificed at 6 weeks to evaluate the injured renal unit. RESULTS: Compared with conventional therapy the absorbable fibrin adhesive bandage applied externally alone or externally and internally resulted in significantly less bleeding and significantly less time to hemostasis (p <0.001). Liquid fibrin and fibrin foam did not reliably achieve hemostasis. Postoperatively computerized tomography and histological sectioning suggested that the absorbable fibrin adhesive bandage results in a stable, durable clot and healing is at least as successful as with conventional treatment. CONCLUSIONS: The absorbable fibrin adhesive bandage appears to be a safe, rapid means of renal salvage after injury.

Animals↗
PubMed2001

[Therapeutic trial on function bandage for military training injuries].

OBJECTIVE: To evaluate therapeutic effectiveness of "Tianniansu" function bandage used for military training injuries (MTI). METHODS: In a randomized tri-blind controlled trial, recruits of all soft tissue injuries and stress fracture (SF) who took part in basic training in 1998 were separated into two groups--A and B with comparability, except the use of bandage. After close follow up on weekly base, part of the patents were subjected by ECT pre and post therapy. RESULTS: Effective rates of bandage A and B on treating soft tissue injuries were 66.7% and 86.4%, respectively. However, in terms of symptoms, detumescence effect of bandage B showed milder than that of A. The effective rate of bandage A and B in treating SF were 67.2% and 75.0%, respectively, but statistically not significant. The treatment effect in 26 injured tibias evaluated by bone scintigraphy pre and post treatment showed that the degree of osteogen injury after treatment was not significantly improved. CONCLUSION: "Tianniansu" function bandage had significant effect on treating soft tissue injuries, but did not have effect in treating SF.

Adult↗
PubMed1986

External compression with elastic bandages: its effect on the peripheral blood circulation during skin traction.

Experiments were performed in rabbits to evaluate the effects of varying degrees of external pressure on the venous circulation in a limb. For these studies, blood volumes and flow rates were determined on surgically exposed veins using a dropcounter. External compression of 30mmHg caused no impairment of the peripheral circulation. At this pressure, flow rates in the greater saphenous vein and popliteal vein were 74% and 124% of their basal rates, respectively. Venous blood flow was absent at pressures exceeding 70mmHg. In healthy human volunteers, the effects of external application of varying degrees of pressures with an elastic bandage during skin traction on the distal portion of the leg were evaluated by plethysmographic and thermometric techniques. Arterial pulsations obtained by photoelectric plethysmography at external limb pressures of 30mmHg were not significantly different in peak amplitude from those obtained without bandaging. External compression of 70mmHg resulted in a decrease in the basal amplitude at 60 minutes that persisted during the rest of the experiment. At 30mmHg compression, no significant changes of skin temperature were noted in the toe; but, at 70mmHg, the skin temperature dropped to 86% of its basal levels during the first hour followed by a further slow fall. Good immobilization of elastic bandages in skin traction was achieved at 30mmHg pressures. In a comparison of bandage application by skilled and unskilled persons, bandage pressures were much more likely to be optimum when the bandage was applied by the skilled.

Adult↗