DRESSINGS AND BANDAGES
                 Claudia Gherman, Răzvan Ciocan 
                        Learning objectives
                        What you should know
                   What is a dressing
                   What is a bandage
                   The basic principles of a bandage
                   Indications of a bandage
                   Types of bandages
                   Bandaging modalities
                   Special types of dressings
                        What you should do
                   List the indications of a bandage
                   List the types of bandages
                   Applya circular bandage
                   Applya spiral bandage
                   Applya spica bandage
                   Applya figure-of-eight bandage 
                   Applyacapeline bandage
                   Applyabandage onone or more fingers
                   List and describe the special types of dressings
                        Definitions
                        A dressing is used to isolate a treated wound in order to 
                 allow  healing. Dressings  are  most  frequently  made  of sterile 
                 gauze, but other materials are also used. In addition to isolating 
                 the wound, dressings allow absorption of secretions and a certain 
                 protection against microbial contamination and trauma.
                        A correct dressing should respect several principles:
                   Any dressing will be applied with the patient in lying position, 
                    rarely in sitting position, and never in standing position
                    o Patients can be impressed by the surgical dressing room, 
                        by  instruments,  and  can  lose  consciousness  and  suffer 
                        trauma from falling; the lying or sitting position allows to 
                        eliminate this risk 
                   The application of a dressing requires two persons: a person 
                    applies the  dressing,  and  the  other  person  provides the 
                    necessary materials
                    o This ensures not only the comfort of the procedure, but 
                        also the maintenance of asepsis
                   A kidney tray will also be available, in which the removed 
                    dressing and the used compresses will be placed
                   Perfect asepsis: the  instruments and  materials used  must be 
                    sterile;  hand  washing  before  and  after  the  application  of  a 
                    dressing, as well as wearing of gloves (sterile – if the dressing 
                    involves manipulation of tissues with the hands, or non-sterile 
                    – if materials and tissues can be manipulated using hemostats) 
                    is compulsory
                   Absorption of secretions will be ensured: gauze compresses, 
                    etc.
                   Asepsis  of  the  wound  will  be  performed  with  antiseptics 
                    adequate for its evolution stage
                        The dressing will be secured with:
                   Silk, cloth or paper surgical tape
                    o Which has advantages:
                          It allows easy wound monitoring 
                          It  does  not  interfere  with  the  functions  of  the 
                           anatomical segment concerned
                    o But also has disadvantages:
                          Removal is painful
                          Sometimes  it  causes  maceration  of  the  underlying 
                           tissue or local reactions (erythema, pruritus)
                   Bandages
                        Bandages or surgical wrappings represent a method for
                 securing dressings, for temporary immobilization or compression 
                 of different body regions.
                        Simple dressings
                        The instruments currently used for dressings are:
                   Surgical hemostat
                   Anatomical hemostat
                   Pan’s forceps
                   Kocher’s forceps
                   Scissors
                   Kidney tray
                  Figure 1. Instruments currently used for dressings: Pan’s forceps, Kocher’s 
                  forceps, scissors, surgical hemostat, anatomical hemostat, kidney tray (from 
                                          left to right)
                        Dressing technique:
                   Hand washing and gloving
                   The old dressing is gently removed
                    o If  this  is  stuck  to  the  wound, it  is  moistened  with 
                        oxygenated water or physiological serum
                   The skin around the wound is cleaned with a swab soaked in 
                    gasoline for degreasing
                    o Application is performed from the wound to the periphery 
                        so as not to contaminate the wound
                   The  skin  around  the  wound  is  disinfected  with  alcohol  or 
                    betadine
                   The wound is treated depending on its nature and evolution 
                    stage
                    o Surgical  wounds  with  aseptic  evolution  do  not  require 
                        special treatments
                    o Secreting  wounds  will  be  cleaned  by  washing  with 
                        antiseptic solutions
                    o Seromas  and hematomas  will  be  drained  using  a  bulb-
                        headed or a hollow probe, after removing 1-2 sutures
                    o Purulent collections  will  be widely  opened  and  drained
                        with tubes 
                   Wound protection  starts  with  the  application  of 2-3  gauze 
                    compresses
                    o For secreting wounds, an additional layer of compresses is 
                        applied (thickness depending on the amount of secretions 
                        in the wound)
                   The dressing is secured with surgical tape or bandage
                               Special types of dressings
                               Grassolind sterile compress
                               It  is  a  sterile 
                      dressing     impregnated 
                      with  a  paraffin-based 
                      fat   substance.  It  is 
                      made of a network of                    Figure 2. 
                      meshes that allow the              Grassolind dressing
                      exudate       to      pass, 
                      Preventing         maceration.         It      stimulates 
                      epithelization and granulation tissue formation. It 
                      is used to cover wounds, burns.
                               Hydrogel dressing
                               It absorbs secre-
                      tions     and    maintains 
                      wound moisture, stimu-
                      lates  healing, and  does 
                      not     adhere     to    the 
                      wound. It is used for
                      Superficial or deep                      Figure 3. Hydrogel dressing
                      Wounds and burns up to grade 2.
                               Sterile gel (Hydrosorb Gel) 
                               It  is  an  absorbent polyurethane gel, 
                      permeable  for  gases  and  vapors  and 
                      impermeable  for  germs  and  fluids;  it  is 
                      available  in  syringes.  The  gel  softens 
                      necrotic  tissue  and  facilitates  its  removal 
                      (debridement),  incorporating  the  exudate 
                      and wound debris. It is used for uninfected                   Figure 4. 
                      wounds and for burns.                                     Polyurethane gel
                               Calcium alginate fiber dressing 
                               It  is  a  hydroactive  dressing  made  of  calcium  alginate 
                      fibers.  It  is  indicated  for  deep, difficultly  accessible  wounds, 
                      infected chronic wounds, fistulas.