A Guide To Compression Dressings For Venous Ulcers
When it comes to long-term ulcers, clinicians can teach caregivers how to apply short stretch reusable bandages.27 The bandages can be washed per manufacturer recommendations and hung to dry. Replace these bandages every few months. Typically to protect the skin, clinicians use a layer of tube gauze or stockinette over the primary wound dressing.
The inelastic or short stretch bandages have limited absorptive qualities and may not be optimal in wounds with heavy or excessive drainage. In such cases, the clinician may consider an initial treatment with an Unna boot or multilayer lower compression bandage to manage the heavy drainage, and transition to the inelastic or short stretch bandage after successful exudate management.
Unna boots are disposable inelastic bandages that have zinc or calamine paste components that may decrease pruritus, dry stasis dermatitis lesions, and help soothe discomfort. One can apply the Unna boot directly over the wound bed or over another primary wound dressing. Then the clinician would secure it with self-adherent cohesive bandaging. This allows for a greater degree of leg conformability as edema decreases. Addition of the elastic outer layer also creates a bandage with a more consistent working pressure and a higher resting pressure.23 Often, it is necessary to apply a middle layer of gauze or cast padding to absorb wound drainage.
What You Should Know About Elastic (Long Stretch) Bandages
The elastic bandages, as their name implies, have high elasticity and are able to stretch up to several times their length. They accommodate the shape of the leg and sustain high pressures during both ambulation and relaxation.5 The table “An Overview Of Compression Products For Venous Ulcers” (above) lists examples of elastic or long stretch bandages.
This bandage type is recommended for patients who are immobile, have a fixed ankle joint or an inadequate calf pump.16 They are not intended for use in patients with arterial insufficiency. Patients can also reuse and wash these bandages according to the manufacturer recommendations. Several companies make high compression elastic bandages that have rectangular or square markings along the bandage to ensure a constant tension during application. One may need to apply padding to prevent localized areas of excessively high pressure, especially over prominent tibial crests.
It is important to note that greater elasticity does not always equate to better efficacy. A bandage with too high an elasticity will provide too low a working pressure to facilitate venous flow. This is because the high elasticity will allow the bandage to flex excessively with each leg movement rather than support the calf pump. A bandage with too high an elasticity will also provide a high resting pressure that may vary along the length of the leg. This variation can hinder venous flow due to uneven pressure gradients and potentially be dangerous in the presence of arterial disease.16
Examples of this type of bandage are those physicians typically use for the management of orthopedic injuries or as surgical dressings such as ACE bandages. ACE wraps are intended for short-term use, not for the treatment of chronic venous insufficiency.