Distal Arms and Legs—Another layer of compression is added to pressure bandages on the distal upper and lower extremities using a fabric and elastic wrap (Figure 4). The extra layer keeps the bandage in place on the upper extremities while the patient continues their daily activities. It also helps prevent edema and pain in the lower extremities.
FIGURE 4. Pressure bandage on the anterior shin followed by application of elastic wrap. There is precise overlap with each pass around the leg.
The degree of postoperative lower extremity swelling varies by patient and procedure performed but largely is inevitable with surgery on the leg, given the potential for superficial lymphatic disruption and the dependent position of the leg when standing. Elevation is always advised, but a well-wrapped, long-stretch elastic bandage provides extra support, especially if the patient has baseline venous insufficiency or needs to be on their feet during the day. The wrap is applied from the distal to the proximal leg with graded compression, overlapping by half with each rotation. The wrap is tightest near the ankle, with gradual and subtle easing of tension as it is placed superiorly.
Healing by Secondary Intention, Full-Thickness and Split-Thickness Skin Grafts, and Partial Wound Closure—These postoperative scenarios require bandages with appropriate pressure; however, dressings need to remain moist against the patient’s skin for comfortable removal, which can be accomplished with petrolatum-impregnated gauze with or without antibacterial properties. The gauze is folded to the appropriate size and placed directly on the wound or sutured in place (Figure 5). A pressure bandage is then applied on top of the gauze.
FIGURE 5. Petrolatum and bismuth tribromophenate gauze folded to size and placed over a wound that will heal by secondary intention.
Practice Implications
The universal bandage kit and instructions for its adaptation to accommodate multiple clinical needs can serve as a helpful resource for dermatologists and their staff.