Head bandaging
To protect the scalp and face, surgeons use several basic techniques.
- Circular bandage is well suited for localized, small wounds on the forehead, temporal, or occipital area.
- If soft tissue or cranial vault bone damage is extensive, a recurrent bandage is chosen: it consists of longitudinal (recurrent) turns that are then securely fixed by circular turns.
- One of the most popular and reliable options is the cap (chepets). Creating it requires a meter-long bandage "tie." Its middle is placed on the patient's crown, and the ends are brought down vertically in front of the auricles (the patient should keep them under slight tension). First, a circular turn is made around the head. Reaching the tie, the bandage is wrapped around it, directed obliquely across the back of the head to the opposite tie, thrown over it again, and led across the fronto-parietal area, partially overlapping the previous layer. Each new turn shifts higher toward the crown until the head is completely covered. At the end, the bandage is fixed with a circular turn or attached to the vertical strip, and the ends of the tie are securely tied under the chin.
- The Hippocratic cap requires using a double-headed bandage or two separate bandages. The first bandage performs exclusively circular anchoring turns across the forehead and occiput. Meanwhile, the second bandage covers the cranial vault, being thrown right and left from the center line. The turns of the second bandage are constantly pressed down and fixed by the turns of the first. The ends are tied in the occipital region.
Eye bandages
The technique of applying the bandage depends on which eye is injured.
Bandaging the right eye is called typical. The process begins with a circular anchoring turn across the forehead, then the bandage is brought down posteriorly to the occiput, passed under the right ear, and brought obliquely upward across the cheek, covering the affected eye. This oblique turn is fixed again with a circular one. During the process, ascending oblique and horizontal circular turns alternate in turn.
If the left eye is injured, an atypical technique is used. It completely repeats the steps of the typical one, but is performed in the reverse direction, while the head of the bandage must be held in the left hand.
To cover both eyes, a binocular bandage is used. It begins as a typical one for the right eye. After circular anchoring, an atypical turn is made: from the right temporal area, the bandage is led from top to bottom onto the left eye. Subsequently, turns alternatingly covering both eyes are alternated with mandatory anchoring circular turns.
Fixation of material on the neck and chest
To reliably cover the back of the neck and the occipital area, an 8-shaped (figure-eight) bandage is optimal.
A regular circular bandage on the neck in its pure form is rarely used due to the high risk of slipping. As a rule, it is combined with an eight-shaped bandage on the forehead area or with a cruciform bandage on the posterior-upper parts of the chest.
On the chest itself and in the shoulder girdle region, larger-scale and more complex techniques are used. These include circular, spiral, cruciform, and spica bandages, as well as special types of bandaging developed for specific clinical cases.
Dressing organization and aseptic rules
Any dressing requires strict compliance with the principles of asepsis to avoid infection entering a clean (aseptic) wound or to prevent secondary infection of burns and purulent foci.
The dressing nurse prepares for the procedure as thoroughly as for surgery: she scrubs her hands, puts on a sterile gown, mask, and gloves. Her duties include setting up the sterile table (using sterile sheets and laying out instruments). With a high patient flow, the nurse hands instruments to the physician, and with a small workload, she can independently perform certain simple dressings under medical supervision.
The physician also scrubs their hands and works in sterile gloves. In some cases, contact with the wound surface is carried out exclusively with instruments, without hand contact.
The standard procedure includes five mandatory steps:
- Anesthesia.
- Removal of the old dressing.
- Wound inspection.
- Toilet and treatment of the skin around the wound with antiseptic solutions.
- Removal of wound discharge: exudate, blood clots, necrotic tissues, and foreign bodies.
Briefly: answers to topical questions
What types of bandages are used on the chest and shoulder girdle region?
The following main types of bandages are used on the chest and shoulder girdle region:
- Circular bandage — circular fixation.
- Spiral bandage — applied to cylindrical segments of the chest.
- Cruciform bandage (figure-eight) — used for the back or chest.
- Spica bandage — used for the shoulder joint.
- Special bandages — include the breast bandage, Desault and Velpeau immobilization bandages, and triangular sling bandages (cravats).
What is the technique for applying a spiral bandage to the chest?
The technique of applying a spiral bandage to the chest includes the sequential execution of circular and oblique turns.
- At the beginning, an anchoring circular bandage is applied above or below the injury site.
- Subsequent turns of the bandage are run in an oblique (spiral) direction.
- Each new turn of the bandage must overlap the previous one by exactly two-thirds of its width.
This type of bandage is used on cylindrical segments of the body, which includes the chest, to reliably cover large wounds.
How is the Desault bandage applied?
The Desault bandage is applied with the arm bent at a right angle and pressed against the torso by alternating four turns.
- The first turn goes circularly from the healthy side to the affected side, pressing the shoulder to the chest.
- The second turn is directed from the healthy axillary region along the anterior surface of the chest to the affected supraclavicular region, then vertically down along the posterior surface of the shoulder.
- The third turn passes through the affected forearm into the healthy axilla.
- The fourth turn goes along the back to the affected shoulder girdle, descends along the shoulder, loops around the elbow from front to back, and returns to the healthy axilla.
What types of bandages are used for injuries and post-surgery of the mammary gland?
To fix dressing material and support the mammary gland, the following types of bandages are used:
- Bandage — applied with a fixing circular turn under the mammary gland and turns covering the gland and passing through the opposite shoulder.
- Triangular sling bandage (cravat) — used to support and fix dressings on the chest.
OSOTU — five steps of dressing: Anesthesia, Removal, Inspection, Skin toilet, Removal of discharge.
Class and exam questions
What is the difference between bandages for the right and left eye?
The bandage on the right eye is applied typically (oblique turns go from bottom to top). On the left eye — atypically, in the reverse direction, while holding the head of the bandage in the left hand.
What is the purpose of the «tie» when applying the cap bandage?
The tie serves as a fixing element. The bandage is wrapped around it at each turn, which ensures reliable retention of the bandage on the cranial vault, after which the ends of the tie are tied under the chin.
Why is a circular bandage rarely applied to the neck in isolation?
It is prone to displacement, so for reliability it is combined with 8-shaped turns on the forehead or cruciform turns on the posterior-upper parts of the chest.
What else to study on this topic
- Technique of applying a spiral bandage to the chest
- Features of the spica bandage for the shoulder girdle
- Figure-of-eight bandage for the upper back and chest
- Special types of chest bandages for specific injuries
- Organization of dressing room workflow in purulent surgery
Master the entire topic in the "General Surgery" course
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