Effect of bandaging techniques on sub-bandage pressures in the equine distal limb, carpus, and tarsus

OBJECTIVE

To determine the influence of 3 types of bandages on sub-bandage pressures over the distal limb, carpus, and tarsus.

STUDY DESIGN

Observational study.

ANIMALS

Eight healthy horses.

METHODS

Each of the 6 following bandages was applied on each horse in randomized order: (1) distal limb compression bandage (DLC), (2) double layer bandage (DL), (3) inner sanctum bandage (IS), (4) carpal compression bandage (CC), (5) tarsal compression bandage (TC), and (6) adhesive elastic carpal bandage (C-ELA). Sub-bandage pressures were measured with the Picopress compression measuring system (Microlab Electonica, Nicolo, Italy) after bandage application. Carpal and tarsal bandage pressures were assessed before and after walking the horses approximately 50 m. TC pressures were also measured after creating a slit over the calcaneus. A generalized linear model was used to test the association of pressure with sensor location, bandage type, time, and potential interactions (P < .05).

RESULTS

DLC (165 mmHg) and IS (167 mmHg) generated greater mean combined pressures compared with DL (146 mmHg; P = .0166). At application, CC (154 mmHg) created higher mean combined sub-bandage pressure compared with C-ELA (70 mmHg; P < .001). Pressures resulting from CC and TC decreased after walking (P < .001), whereas those associated with C-ELA were not affected.

CONCLUSION

Variations to the standard DLC construct did not increase sub-bandage pressures. CC and TC pressures rapidly decreased with ambulation, whereas C-ELA pressures in healthy horses were not affected by walking.

CLINICAL SIGNIFICANCE

Variations to the standard DLC offer no additional benefit in regards to increasing sub-bandage pressures. Carpal elastic bandages maintain sub-bandage pressures during ambulation and may be more appropriate for long term bandaging in ambulating horses. Creating a slit over the calcaneal tuber in TC bandages is discouraged due to rapid decreases in sub-bandage pressure.

Measurement of distal limb sub-bandage pressure over 96 hours in horses

REASONS FOR PERFORMING STUDY

Currently, there is no objective information quantifying pressures exerted by distal limb bandages.

OBJECTIVES

To quantify the pressure exerted by each compression layer, a polo wrap (DLP), a compression bandage (DLC), and to measure the effect of time on sub-bandage pressure.

STUDY DESIGN

Longitudinal observational experiment.

METHODS

A DLC construct included a cotton roll compressed with brown gauze and elastic layers and the DLP construct included a pillow pad compressed by a cloth wrap. Dorsal and lateral sensors were placed on the mid-metacarpus. In healthy horses, sub-bandage pressures were recorded during application (n = 8) and at scheduled time points over the 24 (n = 9) and 96 h periods (n = 8). A generalised linear model was used to evaluate associations between pressure and sensor location, bandage type and time (P<0.05).

RESULTS

For the DLC, dorsal and lateral sensor pressures were 187 mmHg (95% CI 185-189 mmHg) and 142 mmHg (95% CI 133-151 mmHg). Combined sensor pressure after application of the brown gauze was 80 mmHg (95% CI 75-85 mmHg) and rose to 165 mmHg (95% CI 160-170 mmHg) after the elastic layer. Combined pressure at the end of the 96 h period was 135 mmHg (95% CI 123-147 mmHg). For the DLP bandage, location but not time was significant. Combined pressures ranged between 75 mmHg (95% CI 53-97 mmHg) and 85 mmHg (95% CI 63-107 mmHg).

CONCLUSIONS

Pressure distribution was not uniform. The DLP pressures were maintained for a 24 h period. The DLC maintained high pressures for 96 h, but a significant decrease in pressure occurred between 6 and 12 h. Providing there are no other reasons to change a bandage, a 4 day interval between bandages may be appropriate if maintaining distal limb compression is the principal indication.

Compression Therapy: Effects of Posture and Application Techniques on Initial Pressures Delivered by Bandages of Different Physical Properties

OBJECTIVE

To define the pressures and gradients achieved by different bandages when applied by alternative bandaging techniques.

METHODS

An experienced bandager applied six bandages to the same leg of a volunteer using three application techniques. Pressure measurements were taken at the ankle, gaiter, calf and upper calf in three postures.

RESULTS

All bandages gave consistent pressures with all standard deviations falling below 7 mmHg. The percentage increase in pressure from resting leg to standing was inversely related to bandage elasticity. Pressures were similar at the upper calf among the bandages for each application technique in each posture (differences <10 mmHg). Small differences in pressure among the bandages (4-15 mmHg) occurred at the ankle for the resting leg with a reduction in pressure between 6 and 63% at the upper calf compared to the ankle. These differences in ankle pressure were more marked on sitting (differences 15-18 mmHg) and standing (differences 15-27 mmHg), which resulted in substantial differences in gradients.

CONCLUSIONS

Striking variations in pressures and gradients were observed between bandages of different physical properties applied using alternative application techniques. In order to achieve clinical benefits without tissue damage, it is essential that the therapist appreciates how a bandage will react with a specific application technique.

The Use of Pressure Change on Standing as a Surrogate Measure of the Stiffness of a Compression Bandage

OBJECTIVES

To measure interface pressure and stiffness of short-stretch and long-stretch bandages applied with variable strength. These parameters have a deciding influence on the efficacy of compression therapy in chronic venous disease.

DESIGN

Prospective experimental study.

MATERIALS AND METHODS

Compression bandages constructed of different materials were applied with light, moderate and high pressure. Interface pressure was measured over the medial aspect of leg in 12 healthy individuals. Long-stretch bandages were compared to short-stretch bandages. The difference between standing and supine pressure was used to characterise stiffness.

RESULTS

In the low pressure range the median pressure of the final bandage in the supine position was between 18 and 30 mmHg for the long-stretch and 25-33.5 mmHg for the short-stretch bandages (p<0.01, Mann-Whitney U-test). The median differences between standing and supine pressure were between 2.0 and 8.5 for the long-stretch and 6.0-10.5 mmHg for the short-stretch material. In the group of moderate pressure the median values in the supine position were in a range 33.0-58.0 mmHg, for long-stretch and 39.0-49.5 mmHg for short-stretch bandages, with an increase after standing of 6.0-7.0 mmHg with long-stretch, and 14.0-21.0 mmHg with short-stretch bandages (p<0.01, Mann-Whitney U-test). The median supine pressure values in the high pressure group were between 52.0 and 67.0 mmHg for long-stretch and 59.5-67.0 mmHg for short-stretch material. The median increase during standing ranged between 8.5 and 14.5 mmHg in the elastic group and 23.0-33.0 in the inelastic group (p<0.01, Mann-Whitney U-test).

CONCLUSION

A bandage applied with light pressure corresponds to the moderate pressure category of stockings. The difference between the sub-bandage pressure from supine to standing can be used to characterise the stiffness of a bandage.

Multi-layer compression: comparison of four different four-layer bandage systems applied to the leg

OBJECTIVE

To compare performance of four commercial four-layer bandage systems when applied to the leg.

METHODS

Four experienced bandagers applied each system: [Profore Regular (Smith and Nephew); Ultra-Four (Robinson); System 4 (Seton) and K Four (Parema)] to the same leg. Bandages were applied as single layers and as completed systems using standard techniques. For each application, 18 pressure measurements were taken using the Borgnis Medical Stocking Tester (MST) at three measuring points (ankle, gaiter and mid-calf) on medial and lateral aspects in three postures: (horizontal, standing and sitting).

RESULTS

In all 2304 observations were made, 576 for each bandager, 576 for each bandaging system, 768 for each measuring point, 1152 for each aspect and 768 for each posture. The increase in pressure produced by each additional layer was 65-75% of the pressure of the same bandage when used as a single layer. There were significant differences in the final pressures achieved by the bandagers (means: 45-54 mmHg, p<0.001) and between bandage systems (means: System 4: 46 mmHg, Profore: 47 mmHg, K Four: 52 mmHg, Ultra-Four: 54 mmHg; p=0.005). The relationships between the final pressures achieved at each of the three measuring points, the three postures and the two aspects were not consistent among the bandage systems (p<0.01).

CONCLUSIONS

When a bandage is applied as part of a multi-layered system it exerts approximately 70% of the pressure exerted when applied alone, thus challenging the commonly-held assumption that the final pressure achieved by a multi-layer bandaging system is the sum of the pressures exerted by each individual layer. Each of the four bandaging systems exerted different final pressures and gradients and different changes with posture change. These differences have important implications, which could influence the selection (or avoidance) of a particular bandage system according to a patient's condition and circumstances.