Multi-layer compression: comparison of four different four-layer bandage systems applied to the leg

Abstract

Objective: To compare on standardized laboratory models the performance of four commercially available four-layer bandage systems. Methods: Four experienced bandagers applied each of the four systems [Profore® Regular (Smith & Nephew, Hull, UK), Ultra Four (Robinsons, Chesterfield, UK), System 4 (SSL International, Knutsford, UK) and K-Four® (Parema, Loughborough, UK)] to two models: a 12.5 cm diameter padded cylinder and a 9.5-14.5 cm padded cone. Bandages were applied individually in single layers and as a completed system using standard application techniques. Pressures were measured by the Borgnis Medical Stocking Tester at positions corresponding to ankle, gaiter and mid-calf areas as determined by the pressure sensor. Results: A total of 768 observations were made: 384 for each model, 192 for each bandaging system, 192 for each bandager and 128 for each measuring point. The increase in pressure produced by each additional layer was in the range of 50-60% of the pressure achieved by the same bandage when used as a single layer. Each bandage system and each bandager produced a gradient of final mean pressure irrespective of whether the bandage was applied to a cylinder or a cone. However, there were no significant differences in the gradients between the four bandage systems or between the four bandagers. There were significant differences in the final pressures achieved among the bandage systems when applied as completed systems (mean: Profore® = 42 mmHg; System 4 = 45 mmHg; K-Four® = 48 mmHg; and Ultra Four = 51 mmHg; P<0.001). Conclusions: These results challenge a commonly-held assumption concerning the additive effect of pressures generated by successive bandage layers. When applied as part of a multi-layered system each bandage adds just over half the pressure achieved by the same bandage when applied alone. The four completed systems produced pressures within a range appropriate for ulcer therapy, although there were significant differences in mean pressures. This capability of the systems to produce different pressures could be clinically important in the hands of inexperienced bandagers or with patients at risk of pressure damage..

Measurement of distal limb sub‐bandage pressure over 96 hours in horses

“…The DLC is composed of 3 layers, but the inner cotton layer functions to pad the limb from the pressure of the outer layers. Human literature demonstrates that adding more than 2 compressive layers offers limited benefit to the cumulative sub‐bandage pressure . Dale et al .…”

“…The DLC is composed of 3 layers, but the inner cotton layer functions to pad the limb from the pressure of the outer layers. Human literature demonstrates that adding more than 2 compressive layers offers limited benefit to the cumulative sub-bandage pressure [19]. Dale et al [20] demonstrated that when an additional compressive layer is applied to a multilayer bandage construct, it applies only 50-60% of the pressure exerted when applied individually.…”

Effect of bandaging techniques on sub‐bandage pressures in the equine distal limb, carpus, and tarsus

“…Researchers conducting studies in man concluded that applying additional compressive layers did not have a purely additive effect, but a decrease in sub‐bandage pressure has not been reported . Ruckley et al and Dale et al demonstrated that an additional compressive layer in a multilayer bandage construct creates only 50%‐75% of the pressure exerted when applied individually . With regard to the DL, the addition of the second CombiRoll and brown gauze layer further separates the elastic layer from the bandage–skin interface.…”

“…8 Ruckley et al 8 and Dale et al 9 demonstrated that an additional compressive layer in a multilayer bandage construct creates only 50%-75% of the pressure exerted when applied individually. 8,9 With regard to the DL, the addition of the second CombiRoll and brown gauze layer further separates the elastic layer from the bandage-skin interface. In DL, we speculate that the pressure applied by the elastic layer compresses both Combi rolls, dissipating the pressure within the bandage construct and reducing the pressure applied to the skin.…”

Multi-layer Compression: Comparison of Four Different Four-layer Bandage Systems Applied to the Leg

“…11 Next we analysed data when four commercially available four-layer bandaging systems were applied on models. 12 We now compare the same bandaging systems when applied on the leg.…”