The bandage and bandaging: from cotton strip to plastic aerosol.
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This single-centre, randomised, controlled study assessed the wound healing efficacy of adhesive bandages in eligible healthy adults (N = 36) aged 25-55 with Fitzpatrick skin types II and III using a model of laser-induced wounds. Here, we report data for wounds that were randomised to treatment with either a hydrocolloid bandage for multi-day use (BAND-AID Adhesive Bandage Hydroseal), standard of care (SoC) (BAND-AID Adhesive Bandage Tru-Stay Sheer) or an uncovered control. Primary endpoints included the time to complete healing and a composite wound healing score. Hydrocolloid bandage-treated wounds healed twice as fast as the uncovered control or SoC-treated wounds. Median time (days) to complete healing was significantly faster for the hydrocolloid bandage-treated wounds (6.9) versus SoC (11.9) and uncovered control (11.8). Hydrocolloid bandage-treated wounds had significantly better composite wound healing scores versus SoC and versus uncovered control over 2 weeks. At Day 28, cosmesis was better with hydrocolloid bandage treatment (0.3) versus SoC (0.6) and uncovered control (2.1) (change from baseline in a composite scar score; higher score = worse outcome). Multi-day wound occlusion with a hydrocolloid bandage promoted faster healing and improved cosmesis compared with daily SoC dressings or uncovered control.
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.
Bandage treatment in the phlebologic sector may be very successful, yet is seems to be practiced still in too few cases. Mostly bed-rest and treatment in hospital are preferred, methods which include the danger of a beginning deep phlebothrombosis. Propagation of more frequent application of bandages and systematic use of bandage treatment seems necessary, followed by systematic use of elastic stockings, to reduce the number of recidives. Indications of the different bandages and their method of application are discussed.
A study was performed to determine whether the pressures routinely produced by bandaging for compression sclerotherapy of varicose veins are adequate to maintain the superfical veins almost empty of blood. The results suggest that well-applied bandages can provide sufficient support to combat the high distending pressures found in varicose veins. The large variation among different surgeons, however, indicates that any clinical assessment of compression sclerotherapy should include measurement of the pressure at which the bandages are applied.
Different compressive bandages for chronic venous deficiency and lymphedema, are categorized. These categories are not based on the bandage technique itself, but on its effect. The aims of the compression vary in accordance to whether the case involves a diffuse edema brought on by chronic venous deficiency or by lateral trophic problems following malfunctioning of the perforating veins, or difficulties in transporting tissue from the lymphedemas. These various etiological factors must be taken into consideration in the design and use of compressive bandages.
Study of the literature on the prevention of deep vein thrombosis shows the inefficacy of calf bandaging in the ambulation phase. Since thrombosis starts soon after or during operation, prophylactic measures are successful only if performed from the beginning of hospitalization. Orthostatic disturbances are not a general problem in the mobilization phase, as is shown in a study on 20 patients after myocardial infarction or heart surgery in whom leg compression did not influence circulatory regulation. In chronic venous or lymphatic insufficiency, however, compression therapy is of proven value. Such patients should be identified and treated. On the other hand, leg bandaging as a general preventive measure in the mobilization phase is no longer justified, but is indicated in individual patients with venous or orthostatic problems.
The authors performed basic technological, laboratory and clinical examinations of elastic bandages to choose the most proper one helpful to reconstructive operations in temporary ischaemic field, mainly in hand surgery. The physical and mechanical properties, and clinical advantages of chosen elastic bandages applied in 100 operations have been described.
A retrospective analysis was conducted of 100 consecutive cases of penetrating keratoplasty revealing that in 68% of the cases hydrophilic bandage lenses were applied at some time during the course of the operative procedure or postoperatively. In 4% of the cases, lenses were applied before the actual start of keratoplasty and in 13% the lenses were applied before the conclusion of the operative procedure. In 28%, the initial lens application occurred within the first 10 postoperative days while in 18% initial application occurred prior to the time of suture removal. In the remaining 5% of the cases, the lens was applied relatively late in the postoperative course. Primary indications for bandage lens application were prophylactic in cases of infants, chemical burns, exposure, and dry eyes. Therapeutic indications included surface drying and erosion, wound margin defects, patient discomfort, and inflammatory episodes.
The advisability of examination of compressive bandages is discussed. The manner of the therapeutic action in changed leg venous system is given. The methods for examination of the elastic stockings and elastic bandages are presented.
The danger of pressure damage due to bandages is considerable. Plaster casts are incorrect immediately after accidents, repositioning of and operations on limbs. Complaints of circulatory disturbances and pains are to be taken very seriously. Pressure damage may occur not only after plaster casts, but also with elastic bandages. The urgent need to pay attention to undisturbed blood flow to the extremities after accidents and operations is emphasized with reference to 11 cases of various kinds.
The compressive bandaging of limbs as a supportive therapy in venous insufficiency and lymphedema is neither difficult, nor a mystery. The compressive therapy is to be applied exclusively to walking patients. The principles of some types of compressive bandages are explained.
In cataleptic clinging, produced either by catecholamine-blocking drugs or lateral hypothalamic damage in adult cats, rats, or monkeys, bandaging the face and neck causes the head to fall backwards. Early in development, a similar reaction can be seen in normal undrugged infants.
Twenty patients with corneal disease were treated with a recently released soft lens specifically designed for use as a bandage. Patients wore their lenses continuously 24 hr a day. The results were similar to those of previous studies conducted with other lens designs. Improvement was frequent (10 of 12 cases) for bullous keratopathy and corneal graft, burn, or neuroparalytic lesion; limited (1 of 4 cases) for dry-eye syndrome; and absent (4 cases) for irregular cornea and vernal keratoconjunctivitis. No difficulties were found with the concurrent use of medication.
Eight patients with severe keratoconjunctivitis sicca and filamentary keratitis requiring treatment with continuous wear bandage lenses and frequent instillation of artificial tears were studied. The lenses were removed after wear from 3 to 8 weeks and subjected to ultraviolet spectrophotometric evaluation for the presence of the preservative, benzalkonium chloride. No evidence of benzalkonium chloride in the lenses was seen and no clinical evidence of corneal damage was noted. The use of topical medication containing benzalkonium chloride as a preservative in conjunction with hydrophilic lens appears to be clinically acceptable.
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We applied sterile packed cellulose sponges in the dehydrated state as a pressure dressing from skin grafts by using the classic "tie-over" technique. At the end of the procedure, the sponges were hydrated, and provided flat, even pressure to a localized area. By using this simple technique, we obtained 26 of 27 successful free skin grafts with flat apposition.