What is the Ideal Way to Wrap an Ace Bandage? The Relationship between Stretch and Pressure for the Ace Bandage Dressing
Andrew Yang, MD; Karan Dua, MD; Erika Kuehn, MD; Bhaveen H. Kapadia, MD; Dipal Chatterjee, MD; William P. Urban, MD
State University of New York, Downstate Medical Center, Brooklyn, NY
There are many reported problems secondary to the tightness of ace bandages that have led to compartment syndromes, compression injuries, skin abrasions/necrosis, pressure ulcers, and complex regional pain syndrome. Changes in the level of stretch and overlap can lead the bandage to be applied in a safe, low-pressure manner or an unsafe wrap at the level of tourniquet. This study sought to determine the relationship between stretch and pressure under the bandage to identify the ideal amount of stretch with which to apply the dressing.
Healthy individuals without hand pathology were recruited. Patient demographics were collected. The ace bandages were marked with 2cm stripes along one edge of the stretch for each application of the bandage. The pressure measurements were then taken using a pressure transducer by incorporating a 50cc empty normal saline bag into the dressing at the level of the wrist. The dressing was then wrapped over the normal saline bag with 50% overlap at 0%, 10%, 25%, and 50% levels of stretch. The stretch was verified by measuring the increase in length of the 2cm stripe at each marking. A new ace bandage was used for each hand. Pressure measurements were then taken at increasing pressures by increasing the swelling and inflating the normal saline bag at set intervals.
Fifteen patients (n=30 hands; mean age: 35.9 years; 9M:6F) were recruited for this study. Two subjects were left hand dominant (13.3%). Intra-dressing pressures were found to increase linearly, corresponding to the increase in volume of simulated swelling. Also, intra-dressing pressures were found to increase proportionately with increasing amounts of stretch. At 50% stretch, an intra-dressing pressure of 60.11 mmHg (range: 7.51-78.28 mmHg) was observed. At 25% stretch, pressure reached a maximum of 42.52 mmHg (range: 3.77-74.63 mmHg). Even at only 10% stretch, intra-dressing pressure of 30.57 mmHg (range: 0-52.81 mmHg) was measured. Maximal pressure with 0% stretched was 18.75 mmHg (range: 0-38.20 mmHg).
Ace bandages are commonly used dressings; however, most surgeons know from clinical experience that wrapping an ace bandage too tightly can have severe consequences. Studies have shown that the pressure needed to occlude the arteriolar capillaries is between 30-60 mmHg, and the pressure needed to occlude skin microcirculation causing skin necrosis is 60-75 mmHg. The results of the study demonstrate that to keep the ace dressing within a safe zone, the stretch of the ace bandage should be between 0-10%.
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