Classification of Bandages: Fixed and Soft
Globally, all bandages in desmurgy can be divided into two large categories: fixed and soft.
Fixed bandages are used for various diseases and mechanical injuries of the musculoskeletal system. This group includes immobilizing and correcting bandages, as well as traction structures. The basic materials here are plaster of Paris (plaster casts), various splints, and specialized apparatus.
Soft bandages always consist of two elements: the dressing material itself, which contacts the wound, and means for its fixation. According to their main function, they are:
- Simple soft bandages perform a protective or therapeutic (medicinal) role.
- Pressure bandages have a hemostatic effect and are used to stop hemorrhage.
- Occlusive bandages create an airtight seal. This is critically important, for example, in penetrating chest wounds.
For reliable fixation of soft bandages, gauze, net-tubular (retilax) and knit-tubular bandages, cotton triangular bandages, adhesive tape, and special adhesive compositions (collodion, cleol) are used. It is important to remember the basic terminology: the rolled part of the bandage is called the head, and its free end is called the tail.
Circular Bandage
Circular turns traditionally begin the application of any soft roller bandage. However, it is also successfully used as an independent method — predominantly on cylindrical parts of the body (forehead, neck, ankle joint, or wrist).
Application technique:
- Each subsequent turn of the bandage should completely overlap the previous one.
- Special attention is paid to the first (starting) turn. It is applied tightly and at a slight angle (obliquely), leaving a small end of the bandage free.
- This remaining "tail" is folded back over the first turn and securely fastened with the next circular turn.
The only significant disadvantage of the circular bandage is its tendency to rotate around the axis of the limb. During active movements, the bandage may slip, leading to the displacement of the dressing material from the wound.
Spiral bandages and reverse technique
The choice of bandaging technique directly depends on the anatomical shape of the specific body region.
- Simple spiral bandage is used on cylindrical areas (thigh, arm, chest).
- Spiral bandage with reverses is necessary for a snug fit on cone-shaped areas (forearm, lower leg).
How to correctly perform a reverse:
- The bandage is led slightly more obliquely compared to a regular spiral turn.
- The lower edge of the strip is firmly held with the thumb of the left hand.
- The bandage head is unrolled slightly and folded back towards yourself.
- As a result of this maneuver, the upper edge of the bandage becomes the lower edge, and vice versa.
- After the reverse, return to the regular spiral turn.
Golden rule of desmurgy: all reverses must be located strictly along a single line and away from the wound or injury site itself.
Bandages for the chest and shoulder girdle
Specific bandaging options that take into account the anatomy of this area have been developed for the upper torso:
- A spiral or figure-of-eight (cruciate) bandage is usually applied to the chest. The figure-of-eight variant is also excellent for the back.
- A spica bandage is applied to the shoulder joint.
- For reliable immobilization of the entire upper extremity, the Desault bandage is used.
- Special bandages designed for fixing the mammary gland are classified separately.
Joint bandaging: convergent and divergent bandages
Two main techniques are used to cover large joints (elbow and knee). In both cases, the crossing of the bandage turns is always located in the articular fossa (cubital or popliteal).
1. Divergent bandage Begins with circular turns directly over the joint (onto the olecranon or patella). All subsequent turns are applied alternately above and below the starting one, gradually moving away from the center. On the extensor surface, the turns diverge in both directions from the first turn, gradually covering the joint. The structure is secured around the arm or thigh.
2. Convergent bandage Here the principle is the reverse. The starting circular turns are made above and below the joint. With each new turn, the bandage passes cross in the fossa and converge more and more with each other. The dynamics of the turns are directed towards the most convex part of the joint until the area is completely covered.
Briefly: answers to topical questions
What types of bandage dressings exist according to the nature of the bandage turns?
Based on the nature of the bandage turns, several main types of bandages are distinguished.
- Circular — each subsequent turn completely covers the previous one.
- Spiral — turns run obliquely, covering 2/3 of the previous one; it can be simple or with reverses.
- Cruciate, or figure-of-eight (cruciata seu octoidea) — crossing turns alternate with circular ones.
- Spica.
- Divergent — begins with circular turns across the joint, with subsequent turns going higher and lower, crossing in the articular fossa.
- Convergent — begins with circular turns above and below the joint, then the turns gradually approach each other and the most convex part of the joint.
What special bandage dressings are applied to the head and face?
The following special bandage dressings are applied to the head and face region.
- Circular — used for minor injuries of the forehead, temple, and occiput.
- Recurrent — used for extensive injuries of the scalp.
- Cap — a simple and reliable bandage using a "tie" across the vertex.
- Hippocrates' cap (mitra Hippocratis) — applied with a double-headed bandage or two separate bandages.
- Single-eye bandage (monoculus) — a typical bandage with a securing turn across the forehead.
- Double-eye bandage (binoculus).
- Occipital region bandage.
What is the technique for applying the Desault bandage?
The technique of applying the Desault bandage consists of bandaging an arm bent at a right angle to the torso by alternating four turns.
- First turn — a circular pass from the healthy side to the affected side, pressing the arm to the chest.
- Second turn — from the healthy axilla along the anterior chest surface obliquely upwards to the affected supraclavicular region, then vertically down along the posterior surface of the shoulder.
- Third turn — led across the affected forearm into the axilla on the healthy side.
- Fourth turn — from the healthy axilla obliquely across the back to the affected shoulder girdle, descends down the arm, loops around the elbow from front to back, and goes obliquely up the back.
What are the general rules and principles for applying bandage dressings?
General rules for applying bandage dressings require maintaining the correct position of the patient, the body part being bandaged, and the medical professional.
- Patient's position — comfortable for the patient, muscles maximally relaxed, providing free access to the body part being bandaged.
- Position of the bandaged part — functionally advantageous; it must remain immobile during the bandaging process.
- Position of the medical professional — facing the patient to observe facial expressions and monitor pain sensations.
- Bandaging technique — the bandage is led from the periphery of the limb to the trunk, from distal to proximal parts; turns are usually directed from left to right relative to the person bandaging, with possible exceptions.
- Hand work — the right hand unrolls the bandage head, the left holds the dressing and smooths out the bandage turns.
- Contact with the surface — the bandage must roll along the body part being bandaged; preliminary unrolling in the air is not permitted.
- Overlap and tension — tension must be even, with each subsequent turn covering the previous one by 1/2 or 2/3 of its width.
- Fixation — the end of the bandage is secured with a safety pin or adhesive tape, or torn lengthwise and tied around the bandaged part; the knot is placed on the healthy side.
To avoid confusing joint bandage types, focus on the first turn: The Divergent starts Right on the joint (from center to edges), while the Convergent is Shifted above and below (from edges to center).
Class and exam questions
Why is a bandage fold needed when applying a spiral bandage?
The reverse ensures a snug fit of the bandage on cone-shaped body areas (e.g., the lower leg or forearm), preventing it from sliding down.
What is the main disadvantage of a circular bandage?
It is capable of rotating around the limb axis, which can cause the underlying dressing material to shift away from the wound.
How to properly secure the beginning of the bandage on the first turn?
The first turn is applied slightly obliquely and tightly, leaving the end free. This end is then folded back over the first turn and securely covered by the next circular turn.
What else to study on this topic
- Materials for rigid bandages: properties of plaster of Paris, types of medical splints
- Properties of adhesive compositions (cleol, collodion) and application techniques
- Occlusive dressings for penetrating chest wounds
- Step-by-step technique for applying the Desault immobilizing bandage
- Specifics of applying bandages to the mammary gland
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