Medical bandages and plasters represent foundational wound care products with a history spanning millennia — the earliest archaeological evidence of bandaging dates to ancient Egypt (circa 2500 BCE). Modern medical bandaging has evolved into a sophisticated clinical discipline informed by materials science, compression therapy principles, and evidence-based wound care. Bandages serve multiple clinical functions: wound coverage and protection, absorption of exudate, compression therapy (venous/lymphatic disease), immobilization and support (musculoskeletal injuries), and fixation of primary dressings. Understanding the indications, mechanisms, and application techniques for different bandage types is essential for effective clinical practice.
Design: Lightweight, elasticated cotton or cotton-viscose blend with high conformability and moderate stretch (40-60% elongation). Available in multiple widths: 2.5 cm, 5 cm, 7.5 cm, 10 cm, 15 cm.
Mechanism: Conforms to body contours, securing primary dressings without restricting movement or circulation. Elasticity allows for edema fluctuation without bandage loosening or constriction.
Clinical Applications: Retention of primary wound dressings on joints and mobile body areas, light support for minor sprains and strains, fixation of splints, securing of wound pads on irregular surfaces (face, neck, axilla, groin).
Application: Apply with 50% overlap in spiral turns. Do not apply under tension — conforming bandages are for retention, not compression. Secure with tape (not metal clips — these are difficult to remove for radiography).
Contraindications: Should not be used for compression therapy — insufficient elasticity and sustained tension. Not suitable for high-exudate wounds without absorbent primary dressing.
Design: 100% cotton with minimal elasticity (30-60% elongation). High working pressure with low resting pressure.
Mechanism: Creates a semi-rigid cylinder around the limb. During muscle contraction (walking), the calf muscle expands against the non-yielding bandage, generating high intermittent compression pressures (60-80 mmHg) that augment the calf muscle pump. At rest, resting pressure remains low (20-30 mmHg), maintaining comfort and arterial inflow. This high working pressure / low resting pressure profile makes short-stretch bandages suitable for patients with mixed arterial-venous disease where sustained high compression could compromise arterial perfusion.
Clinical Applications: Venous leg ulcer management (in patients with adequate arterial supply, ABPI 0.8-1.2), lymphedema management (Phase II maintenance), chronic venous insufficiency (C4-C6 CEAP classification).
Evidence: Short-stretch bandages demonstrate equivalent healing rates to multi-layer compression systems for venous leg ulcers (Cochrane systematic review, 2018). Advantage in patients with mixed arterial-venous disease due to low resting pressure.
Application: Applied at full stretch from metatarsal heads to tibial tuberosity (or below knee for lymphedema). Overlap 50% in spiral with figure-of-eight technique at ankle. Pressure highest at ankle, graduating proximally. Requires trained clinician for correct application — pressure is technique-dependent.
Design: Cotton-elastane blend with high elasticity (120-200% elongation). High working pressure AND high resting pressure.
Mechanism: Continuous compression in both active and resting states. Provides sustained compression but does not generate the high intermittent pressures of short-stretch bandages during muscle contraction. Resting pressure remains elevated — potential concern for nocturnal compression when leg is elevated and immobile.
Clinical Applications: Acute soft tissue injury management (sprains, strains, contusions) — combined with RICE protocol, post-cast/splint edema management, mild to moderate venous insufficiency, sports medicine applications.
Application: Apply at 50-75% stretch (not full stretch — generates excessive pressure). Spiral technique with 50% overlap from distal to proximal. Distal pulse, capillary refill, and sensation must be checked after application. Remove or loosen at night unless specifically instructed otherwise (acute injury compression).
Contraindications: Severe peripheral arterial disease (ABPI <0.5), uncompensated congestive heart failure (compression increases venous return to right heart), acute deep vein thrombosis (contraindicated until anticoagulated and stable).
Design: Pre-packaged system of 2-4 bandage layers designed to be applied in specific sequence to achieve target interface pressure (typically 40 mmHg at ankle graduating to 17 mmHg below knee). Layers include: orthopedic wool (padding, redistribution of pressure), crepe bandage (retention, smoothing), elastic compression bandage(s) (therapeutic compression).
Clinical Applications: Gold standard for venous leg ulcer treatment per WUWHS and Society for Vascular Surgery guidelines. Reduces healing time by 30-50% compared to no compression or inadequate compression.
Evidence: Strongest evidence for any wound care intervention. Cochrane review (2021, 20 RCTs, n=3,098) demonstrated that multi-layer compression systems achieve higher healing rates than single-layer compression (RR 1.31 for complete healing at 12 weeks).
Application: Prescribed system — order of layers is specific and deviation reduces therapeutic effectiveness. Ankle-brachial pressure index (ABPI) must be measured before application (ABPI <0.8 requires reduced compression or vascular specialist consultation). Requires trained clinician — incorrect application can cause pressure damage, particularly over bony prominences and the anterior tibial crest.
Design: Bandage impregnated with plaster of Paris (calcium sulfate hemihydrate) or synthetic polyurethane resin. Plaster: low cost, excellent conformability, heavier, longer setting time. Synthetic (fiberglass): lighter, stronger, faster setting, more expensive, water-resistant options available.
Clinical Applications: Fracture immobilization (definitive or temporary/splint), post-operative immobilization (tendon repair, ligament reconstruction, joint arthroplasty), correctional casting (serial casting for contracture management — e.g., clubfoot Ponseti method), functional bracing.
Application: Requires specific training and competency assessment. Key principles: (1) Stockinette and cast padding applied first — padding extra over bony prominences (malleoli, ulnar styloid, patella, olecranon, calcaneus), (2) Immerse bandage in water at manufacturer-specified temperature (colder = longer setting time, more working time), (3) Apply with 50% overlap, molding to limb contours during application — do not indent with fingers (creates pressure points), use palms, (4) Position limb in desired immobilization position during setting — do not move during exothermic reaction (plaster becomes warm during setting).
Complications: Compartment syndrome (surgical emergency — pain out of proportion, pain with passive stretch, paresthesia, pallor, pulselessness [late sign]), pressure sores (over inadequately padded bony prominences), cast saw burns/abrasions during removal, joint stiffness, muscle atrophy, DVT (lower limb casts).
Design: Absorbent pad with adhesive backing in various configurations: strip (finger/hand), knuckle, fingertip, spot (circular), island dressing, butterfly closure strips. Available in fabric (conformable), plastic/vinyl (water-resistant), and clear (low-visibility) backing materials.
Clinical Applications: Minor wound coverage (cuts, abrasions, blisters), wound closure support for superficial lacerations (butterfly strips), post-phlebotomy/injection site coverage, nail bed injury protection, friction/blister prevention.
Selection by Wound Site:
| Clinical Need | Bandage Type | Key Consideration |
|---|---|---|
| Dressing retention (routine) | Conforming bandage | Do not apply under tension |
| Venous leg ulcer / CVI | Multi-layer compression or short-stretch | ABPI measurement mandatory |
| Acute sprain/strain | Long-stretch elastic (ACE-type) | Remove at night unless otherwise directed |
| Lymphedema (maintenance) | Short-stretch bandage | Requires specialized training |
| Fracture immobilization | Plaster or synthetic cast tape | Neurovascular assessment before and after |
| Minor wound / abrasion | Adhesive plaster (Band-Aid-type) | Change daily or when soiled/wet |
| Post-phlebotomy | Spot/circular plaster | Apply pressure before plaster placement |
Before any bandage application, perform and document: (1) Skin assessment — integrity, edema, sensation, arterial supply (palpable pulses, capillary refill, ABPI if compression planned), (2) Neurovascular status — motor function, sensation, pulses, capillary refill, color, temperature, (3) Post-application neurovascular check — repeat assessment within 30 minutes, (4) Patient education — signs/symptoms of neurovascular compromise, activity restrictions, bandage care, follow-up plan. Any deterioration in neurovascular status after bandage application requires immediate removal and reassessment — do not delay. Linmed Medical provides a complete range of medical bandages and plasters across all major categories: conforming retention bandages, compression bandage systems (short-stretch, long-stretch, multi-layer), plaster and synthetic casting tape, and adhesive wound plasters — all manufactured under ISO 13485:2016 quality systems with CE certification.
