Choosing the right bandage

Choosing the right bandage depends on several factors, not least of which is whether you use the term bandage interchangeably with dressing. Technically speaking, a bandage is mostly used to hold a dressing in place, and it never comes into direct contact with a wound. Bandages can also be used to support a splint, to support the body, or to restrict a part of the body. Nonetheless, the concepts of bandage and dressing have become synonymous to a large extent. What’s more, there are certain products where the two categories overlap, such as gauze, which is the most common type of bandage/dressing.

Gauze is made with thin, woven material that is used either to keep a dressing in place, or applied directly over a wound; in the latter case it will feature a Telfa absorbent barrier – and/or polymers or antibiotic ointments- to prevent it from to sticking to the wound bed. Gauze is recommended for draining wounds, pressure or trauma wounds, packing or debridement, surgical incisions, gaping wounds, and tunnel, tracts, or undermining wounds. Gauze is widely available in many sizes and forms and can be used on multiple types of wounds in such a way that other topical products may be added, and is reduces wound adherence. On the other hand, it requires a secondary dressing –or bandage-, needs frequent changes should the wound dry, its fibers may adhere to the wound, and is not advised for moist wound management.

Another type of bandage is known as compression or elastic bandage. Furthermore, there are two types of compression bandages; short stretch compression bandages, and long stretch compression bandages. The former shortens after application and provides resting pressure to a limb, typically to treat lymphedema or venous ulcers; the latter on the other hand can be adjusted but has to be removed during the night or when the patient is in a resting position. Short stretch bandages do not exert extra pressure on a wound and are considered viable for long-term treatment, while long stretch bandages may cause harmful pressure if left on a wound for long periods.

If you don’t make any distinction between bandages and dressings, then choosing the right bandage depends on whether the wound is wet or dry, whether there is slough or necrotic tissue, or whether there are infection signs. Dry wounds can benefit from dressings that donate water molecules to dehydrated tissue in order to establish a moist wound environment. Hydrogel bandages consist of 80% to 90% water, and are indicated wounds with minimal to no excess fluid, stages II through IV pressure ulcers, painful wounds, necrotic wounds, donor sites, radiation burns, and infected wounds. Hydrogel dressing relieves pain and can be removed without causing trauma, but has low absorption, needs a secondary dressing, and may have to be changed every day.

Gauze or transparent film may suffice for a granulating wound bed with no slough, eschar or necrotic tissue. Transparent film is a thin, clear, two sided sheet with a special adhesive to protect the wound; it does not stick to the moist surface of the wound and it seals bacteria and other fluids out. This type of bandage is ideal for superficial burns, thick wounds, stages I through II pressure ulcers, donor sites, to cover an IV site, and as a secondary dressing. Transparent film is flexible, reduces friction and shearing, allows visualization of the wound site while providing full protection, and needs be change only every 5 to 7 days. The downside is that it may adhere to certain wounds, doesn’t absorb moisture, lacks oxygen, and is not recommended for 3rd degree burns or draining wounds.

However, if there is necrotic tissue then a bandage that promotes autolytic debridement is the best choice, such as a hydrocolloid or alginate dressing. Hydrocolloid includes a gel-forming agent that develops an absorbent, self-adherent, water-resistant seal. Hydrocolloid is used in low and moderately draining wounds, underneath compression wraps or as a stocking, as a preventative measure for high-risk friction areas, necrotic wounds, and stages I through IV pressure ulcers. Hydrocolloid bandages are easy to apply but difficult to remove, as they may adhere to the wound. Additionally, it is comfortable and decreases pain. Alginate can absorb up to 20 times its weight in fluid exuding from moderate to highly draining wounds, packing wounds, and stages III to IV pressure ulcers. Alginate is easy to remove and requires fewer changes, but does need a secondary dressing.   

Infected wounds can use silver-saturated bandages that can reduce the bioburden of the wound. Silver dressing is used to manage staph infections, chemical burns, 3rd degree burns, secondary radiation wounds, infection-prone wounds, and stage I pressure ulcers. Silver bandages are economical and latex-free, but may require a secondary dressing and moisture to trigger silver release (to which some people may be sensitive).

Related Read: What to add to a Compact First Aid Kit?