Introduction

Bandages and compression therapy (CT) is used for dressing retention, support and compression (54). CT is the cornerstone of treatment for venous and lymphatic disorders. It is essential in deep vein thrombosis and superficial phlebitis, as well as in chronic conditions like chronic venous insufficiency, gravitational dermatitis, lipodermatosclerosis, leg ulcers and lymphedema. Underestimated, or even totally ignored by many physicians, CT is often poorly prescribed and demonstrated to the patients, who may then discard the most effective and economical treatment of their condition (83). 

 

Mechanisms Involved

Its beneficial effects have been well known for centuries. CT’s mechanisms of action may be classified as follows: Venous: compression may achieve narrowing of veins, restoration of valvular competence, partial regression of parietal degenerative changes, reduction or suppression of superficial and deep venous reflux, diminution of venous pressure, acceleration of venous flow, improvement of venous pumping, diminution of venous pool, and blood shift into central compartment. Arterial: reduction of cutaneous arterial perfusion, then paradoxal improvement of arterial flow as a result of edema reduction (83). 

 

Lymphatic: improvement of lymphatic function and drainage. Microcirculatory: oedema reduction, acceleration of capillary blood flow, diminution of inflammatory mediators. Tissular: increase of intratissular pression, decrease of proteins tissular concentration, softening of lipodermatosclerosis. Hematological: enhancement of fibrinolysis. Numerous investigative techniques have been used to demonstrate these effects, including echography, phlebography, foot volumetry, peripheral venous pressure measurements, xenon 133 clearance and more (83).

 

Contraindications, Side Effects, and Limitations

Stage III and IV of obliterative arterial disorders, or a systolic arterial pressure at the ankle of less than 80

MmHg, contraindicate elastic supports. Adhesive bandages may be considered in arterial patients with extreme caution and only if resting pressure is nil. Other relative contraindications include poorly compensated heart failure and abscesses. Complications such as nerve damage, skin necrosis, induced arterial hypoxia, and DVT are exceptional, if both indications and the CT technique are correct. True allergies to CT materials are rare. First placing a cotton stockinette may prevent irritation of sensitive skin by CT. The major limitations of CT are patient compliance and difficulty in applying hosiery or bandages in the elderly (83).

 

Types Available

• Light-weight conforming bandages: Used for dressing retention. Aims to keep dressing close to the wound without inhibiting movement or restricting blood flow. Greater elasticity than cotton conforming bandages.

• Tubular bandages and garments: Bandages: available in different forms.  Used under orthopaedic casts, or protecting topical creams/ ointments. Suitable for retaining dressings, but not for pressure application due to the inadequate pressure exerted. Compression hosiery: reduces recurrence of venous leg ulcers. Should be used after wound healing. Silk clothing: an alternative to elasticated viscose stockinette garments. Used to manage severe eczema and allergic skin conditions.

• Support bandages: includes various crepe bandages. Used in oedema prevention. Provides light support.

 

• Elastic adhesive bandages: provides compression in treatment of varicose veins and supports injured joints. (Should no longer be used to support fractured ribs and clavicles). Used with zinc paste bandage in venous ulcer treatment but may produce inadequate pressure.

• Cohesive bandages: Adheres to itself and not the skin. Provides support for sports use, sprained joints and as an outer layer for multi-layer compression bandaging. Avoid use if arterial disease suspected.

• Compression bandages: High compression products are used to provide pressure required for management of gross varices, post-thrombotic venous insufficiency, venous leg ulcers, and gross oedema in average sized limbs. Must be correctly applied. Doppler testing is required before initiation.

 

• Multi-layer compression bandaging: Alternative to high compression bandages for treating venous leg ulcers. Compression is achieved by the effects of 2-3 extensible bandages applied over a layer of orthopaedic wadding and a wound contact dressing.  

• Medicated bandages: zinc paste bandages: used with compression bandaging for treating venous leg ulcers. Also used with coal tar, calamine or ichthammol in skin conditions e.g. eczema.

• Compression (elastic) hosiery and garments: used to treat conditions associated with chronic venous insufficiency, prevention of recurrent thrombosis or reduce risk of further venous ulceration. Doppler testing (confirming arterial sufficiency) is required before initiation. Quantity, article and compression class must be specified on prescription. Comes in 3 classes providing light to strong support.

• Lymphedema garments: Used to maintain limb shape and prevent additional fluid retention. Comes as flat or circular knitted garments, in light to high compression (54).