Class-3c compression bandaging for venous ulcers: comparison of spiral and figure-of-eight techniques

Abstract

Aim. This paper reports a study to compare the differences in compression produced on a limb using a spiral and a figure-of-eight bandaging technique. Background. Chronic leg ulcers are a major health problem in Western countries. Compression bandaging is the accepted treatment for venous leg ulcers. The spiral and the figure-of-eight techniques are traditional methods of applying compression bandages. but their performance in terms of pressure profiles is unknown. Despite a lack of evidence about technique, class-3c compression bandages are not currently recommended for application in a figure-of-eight as this is thought to produce dangerously high pressure. Methods. A cross-over experimental design was used with a sample of 26 nurse bandagers. Consistency of performance was tested. Bandage stretch and overlap were measured and analysed by standard deviation to ensure that the techniques were consistent and repeatable. Pressure probes were then applied to the medial, posterior and lateral aspects of the lower limb of a healthy volunteer. The class-3c compression bandage was applied using both techniques and the pressure profiles around the leg were measured under the bandage. The results of each technique were compared using independent sample t-tests. The data were collected in 1999. Results. The figure-of-eight technique provided statistically significantly higher compression at lower areas of the leg than the spiral technique. Mean pressure difference was 20·3 mmHg at the ankle, 22·2 mmHg at the gaiter, 9·4 mmHg at the calf. The pressure differences decrease towards the knee with both techniques and decrease more steeply with the figure-of-eight technique. Conclusion. The spiral technique was a safe and comfortable method of bandage application. The figure-of-eight also provided graduated compression but with some high areas of pressure, notably overlying the Achilles tendon. However, before firm practice recommendations are made, replication of the study using a padding layer and a larger sample is needed.