The use of occlusive dressings (OD) as a tactical wound healing aid in military operations has increased dramatically over the past 20 years. In 2000, synthetic wound care products were rarely sold, whereas in 2021, it was estimated that organizations spent more than US$450 million on these dressings in one year.
Currently, the use of an occlusive dressing is an effective method of combating wounds in the field and in extreme situations.
Reasons for the development of the disease
The main causes of trophic ulcers are:
- extensive skin damage;
- burns;
- frostbite;
- chemical, radiation exposure;
- diabetes;
- phlebeurysm;
- thrombophlebitis;
- atherosclerosis;
- allergic reactions;
- bedsores;
- pathologies of the peripheral nervous system;
- tuberculosis, syphilis.
Also, a trophic ulcer can occur due to an infectious process in the body or metabolic disorders.
Main symptoms
In the early stages, the defect is accompanied by swelling, itching, and thinning of the skin in the problem area. The following symptoms then develop:
- the skin becomes as thin as possible, becomes glossy, almost transparent;
- Stagnant lymph begins to appear on the surface of the dermis;
- chills and convulsions occur;
- the top layer of skin begins to peel off, resulting in an ulcer;
- the affected surface becomes infected, purulent discharge appears.
Trophic ulcers on the legs cause severe pain at the slightest touch. It is difficult to treat, so it is extremely important to start therapy in a timely manner. It is necessary to consult a doctor who will conduct a comprehensive diagnosis, select the correct treatment tactics and prescribe a number of rehabilitation measures.
Treatment of trophic ulcers
Therapy for skin ulcers is aimed at:
- elimination of lymph stagnation, swelling of soft tissues;
- healing of an open wound, preventing the development of dermatitis;
- prevention of recurrence of ulcers.
One of the most effective ways to treat trophic ulcers on the legs is special wound dressings. They maintain the environment, absorb secretions, disinfect the wound, promote rapid healing, and significantly reduce pain.
Purpose of dressings
Wound healing dressings for trophic ulcers must fulfill a number of requirements:
- provide a sterile environment, preventing infections from entering an open wound;
- stimulate the formation of granulation tissues;
- provide an environment favorable for healing processes;
- clean the surface of the wound from dead tissue and secretions;
- protect the ulcer from physical damage, friction, foreign particles, fibers;
- be hypoallergenic and vapor permeable;
- If necessary, it can be easily removed without causing pain to the patient.
You should not engage in amateur activities and try to treat trophic ulcers with folk remedies. This can lead to extremely serious consequences, including the development of gangrene and amputation of the limb.
Lower limb bandages
Returning bandage on the toes. Used for diseases and injuries of the toes. Bandage width 3-5 cm.
The bandage is usually used to hold the dressing material on the wounds of 1 toe and rarely to cover the other toes, which are usually bandaged along with the entire foot.
The bandage starts from the plantar surface of the base of the finger, covers the tip of the finger and runs the bandage along its back surface to the base. Make a bend and creep the bandage to the tip of the finger. Then they bandage it with spiral rounds to the base, where the bandage is fixed.
Spiral bandage on the first toe (Fig. 40). The width of the bandage is 3-5 cm. Usually only one thumb is bandaged separately. It is recommended to begin bandaging with strengthening circular tours in the lower third of the shin above the ankles. Then the bandage is passed through the dorsum of the foot to the nail phalanx of 1 finger. From here, spiral rounds are used to cover the entire toe to the base and again through the back of the foot the bandage is returned to the lower leg, where the bandage is finished with fixing circular rounds.
Fig.40. Spiral bandage for big toe
Spica bandage on the first toe (Fig. 41). The width of the bandage is 3-5 cm. Like all spica bandages, the spica bandage for the first toe is bandaged in the direction of the injury. On the left foot the bandage is applied from left to right, on the right foot - from right to left.
Bandaging begins with strengthening circular tours in the lower third of the shin above the ankles. Then the bandage is carried from the inner ankle to the back of the foot to its outer surface and along the plantar surface to the inner edge of the nail phalanx of the first toe. After a circular turn on the first toe, the bandage is moved along the dorsum of the foot to its outer edge and the bandage is moved in a circular turn through the plantar surface to the outer ankle.
Fig.41. Spica bandage for the big toe
Each subsequent round of the bandage on the first finger moves upward in relation to the previous one, thus forming an ascending spica-shaped bandage. Returning bandage on the peripheral parts of the foot. Used for diseases and injuries of the peripheral parts of the foot and fingers. Bandage width – 10 cm.
Each finger is covered with a dressing separately, or all fingers together with gauze pads between them. Then they begin to bandage the foot. Circular strengthening tours are applied to the midfoot. After that, using longitudinal returning tours from the plantar surface of the foot through the tips of the toes to the dorsum and back, the entire width of the foot is covered. The bandage is carried along a creeping path to the tips of the fingers, from where the foot is bandaged in spiral rounds to the middle. The bandage on the foot usually does not hold well, so it is recommended to finish the bandage with strengthening figure-eight rounds around the ankle joint with fixing circular rounds above the ankles.
Returning bandage for the entire foot (Fig. 42). It is used for foot injuries when it is necessary to cover the entire foot, including the toes. Bandage width – 10 cm.
Rice. 42. Returning bandage for the entire foot
Bandaging begins with circular fixing rounds in the lower third of the shin above the ankles. Then the bandage is transferred to the foot, from the side of the inner ankle on the right foot and from the outside ankle on the left, and several circular strokes are applied along the lateral surface of the foot to the first toe, from it back along the opposite lateral surface of the foot to the heel. From the heel, the bandage is carried in a creeping motion to the tips of the fingers and the foot is bandaged in spiral moves in the direction of the lower third of the lower leg. In the area of the ankle joint, the technique of applying a bandage to the heel area is used (Fig. 44). Finish the bandage with circular rounds above the ankles.
Cross-shaped (eight-shaped) bandage on the foot (Fig. 43). Allows you to securely fix the ankle joint in case of ligament damage and some diseases of the joint. Bandage width – 10 cm.
The foot is placed in a position at right angles to the lower leg. Bandaging begins with circular fixing rounds in the lower third of the shin above the ankles. Then the bandage is moved obliquely along the dorsum of the ankle joint to the lateral surface of the foot (to the outer surface of the left foot and to the inner surface of the right foot). Perform a circular motion around the foot. Next, from the opposite side surface of the foot along its back, they cross the previous course of the bandage obliquely upward and return to the lower leg. Again, perform a circular move over the ankles and repeat the eight-shaped moves of the bandage 5-6 times to create reliable fixation of the ankle joint. The bandage ends in circular motions on the shins above the ankles.
Rice. 43. Cross-shaped (eight-shaped) bandage on the foot
Bandage on the heel area (tortoiseshell type) (Fig. 44). Used to completely cover the heel area like a divergent tortoiseshell bandage. Bandage width – 10 cm.
Bandaging begins with circular fixing rounds on the shins above the ankles. Then the bandage is applied obliquely down the back surface to the ankle joint. The first circular tour is applied through the most protruding part of the heel and the dorsum of the ankle joint and circular strokes are added to it above and below the first one. However, in this case, there is a loose fit of the bandage to the surface of the foot. To avoid this, the bandages are strengthened with an additional oblique move of the bandage, running from the back surface of the ankle joint down and anteriorly to the outer lateral surface of the foot. Then, along the plantar surface, the bandage is moved to the inner edge of the foot and the diverging rounds of the tortoiseshell bandage continue to be applied. The bandage ends in circular circles in the lower third of the shin above the ankles.
Fig.44. Heel bandage
Spica-shaped ascending bandage on the foot (Fig. 45). It is used to reliably hold dressing material on the dorsal and plantar surfaces for injuries and diseases of the foot. The toes remain uncovered. Bandage width – 10 cm.
Bandaging begins with circular fixing rounds through the most protruding part of the heel and the back surface of the ankle joint. Then, from the heel, the bandage is moved along the outer surface of the right foot (on the left foot - along the inner surface), obliquely along the back surface to the base of the first toe (on the left foot - to the base of the fifth toe). Make a full circle around the foot and return the bandage to the back surface at the base of the fifth toe (on the left foot - at the base of the first toe). Along the back of the foot, they cross the previous round and return to the heel area on the opposite side. Going around the heel from behind, repeat the described eight-shaped rounds of the bandage, gradually shifting them towards the ankle joint. The bandage ends in circular circles in the lower third of the shin above the ankles.
Fig.45 . Spica bandage on the foot
Foot bandages. There are scarves that cover the entire foot, heel area and ankle joint.
Scarf bandage for the entire foot (Fig. 46 a, b). The plantar area is covered with the middle of the scarf, the top of the scarf is wrapped, covering the toes and the back of the foot. The ends are brought to the back of the foot, crossed, and then wrapped around the shin above the ankles and tied with a knot on the front surface.
Fig.46 . Foot bandages:
a b – for the entire foot; c – on the heel area and ankle joint area
Scarf bandage on the heel area and ankle joint (Fig. 46 c). The scarf is placed on the plantar surface of the foot. The base of the scarf is located across the foot. The apex is located along the back surface of the ankle joint. The ends of the scarf are crossed first on the back of the foot, and then over the top of the back surface of the ankle joint and the lower third of the lower leg. The ends are tied on the front surface of the shin above the ankles.
Spiral bandage with bends on the lower leg (Fig. 47). Allows you to hold the dressing material on wounds and other injuries of the lower leg, which has a cone shape. Bandage width – 10 cm.
Bandaging begins with fastening circular tours in the lower third of the shin above the ankles. Then they make several circular spiral rounds and on the cone-shaped area of the lower leg they switch to bandaging with spiral rounds with bends similar to the spiral bandage on the forearm. The bandage ends in circular circles in the upper third of the leg below the knee joint.
Rice. 47. Spiral bandage on the shin (general view)
Scarf bandage on the shin (Fig. 48). The base of the scarf is wound around the shin in a helical manner. The lower end of the scarf is carried over the ankle area and directed slightly upward, where it is secured with a pin. The other end of the scarf covers the upper part of the shin from above in a circular motion and the end is also secured with a pin.
Fig.48. Shin bandage
Turtle bandage for the knee joint area . Allows you to securely hold the dressing material in the area of the knee joint and the areas immediately adjacent to it, while movements in the joint are slightly limited. If there is damage directly in the area of the knee joint, a converging turtle bandage is applied, and if there is damage near the knee joint, a divergent bandage is applied. The bandage is applied in a position of slight flexion in the joint. Bandage width – 10 cm.
Converging turtle bandage on the knee joint area (Fig. 49 a, b). Bandaging begins with fastening circular tours in the lower third of the thigh above the knee joint or in the upper third of the lower leg below the knee joint, depending on where the wound or other damage is located. Then, converging eight-shaped rounds of bandage are applied, crossing in the popliteal region. The bandage ends in circular circles in the upper third of the leg under the knee joint.
Fig.49. Tortoise knee bandage:
a, b – convergent; c – divergent
A diverging tortoiseshell bandage for the knee joint (Fig. 49 c). Bandaging begins with securing circular tours through the most protruding part of the patella. Then eight-shaped diverging moves are performed, crossing in the popliteal region. The bandage ends in circular circles in the upper third of the leg or lower third of the thigh, depending on where the damage is located.
If it is necessary to apply a bandage to the lower limb in an extended position, use a spiral bandaging technique with bends. The bandage begins with circular moves in the upper third of the leg and ends with fixing rounds in the lower third of the thigh.
Spiral bandage with bends on the thigh. It is used to hold dressing material on wounds and other injuries of the thigh, which, like the lower leg, has a cone shape. Bandage width – 10-14 cm.
Bandaging begins with securing circular tours in the lower third of the thigh above the knee joint. Then the entire surface of the thigh is covered from bottom to top using spiral moves of the bandage with bends.
As a rule, such bandages on the thigh are poorly held and easily slip off. Therefore, it is recommended to complete the bandage with rounds of a spica bandage on the hip joint area.
Basic principles for choosing a wound patch
The choice of dressing directly depends on the condition of the wound at the moment. They come in hydrogel, sponge, mesh, and with antimicrobial agents. If the ulcer is accompanied by wet necrosis, antimicrobial dressings with alginates are indicated to disinfect wounds and promote rapid healing. The patch should be used only as prescribed by your doctor. But if it is not possible to consult with him, buy a bandage with broad-spectrum antiseptics, and not with a specific antibiotic.
If the wound is dry, covered with dead tissue and a dense yellow coating, it is necessary to perform surgical treatment in a hospital setting. However, in some situations the attending physician cannot do this:
- There is a possibility of heavy local bleeding;
- The patient suffers from diabetes, as a result of which the risk of infection in the wound significantly increases;
- The patient is in a serious condition, and surgery can seriously aggravate it.
The best solution to this problem is the use of hydrogel patches. They moisturize the ulcer, soften dead tissue, after which it can be easily and safely removed by a doctor. The visible effect of wearing the bandage occurs within 3-4 days.
After you have managed to cope with the acute inflammatory phase, you should wear alginate dressings. They are completely natural and organic. They contain fibers from dried seaweed. The wound-healing patch is able to absorb large amounts of discharge, ensuring the cleanliness of the wound and maintaining an optimal moist environment for healing.
For what wounds is an occlusive dressing applied?
These dressings are used to seal certain types of wounds and surrounding tissues from air, liquids and harmful contaminants such as viruses and bacteria during trauma or first aid. It is often used as a direct means of monitoring wound cleanliness and also to reduce blood loss when hospital treatment is not possible.
An occlusive dressing is used for pneumothorax and complements hemostatic agents for cuts and lacerations. In some cases, it is used for open rib fractures and injuries to the upper respiratory tract.
How to apply a bandage correctly
There are several simple conditions for applying a bandage that must be observed if you do not want to aggravate the situation and introduce infection into the wound:
- Before the procedure, be sure to thoroughly wash your hands with soap and disinfect them with an antiseptic;
- Do not touch the affected area with your hands under any circumstances;
- use only sterile dressings sold in individual sealed packages;
- To further secure the patch and prevent it from moving, use special self-fixing bandages.
Following simple rules will help you achieve visible progress just a few days after applying the wound-healing bandage. It is important to strictly follow your doctor’s prescriptions and the instructions on the patch package.
Application of an occlusive dressing for pneumothorax
An occlusive dressing for open pneumothorax should be applied within 10-15 minutes after injury. Otherwise, additional drainage or preliminary soaking of the wound with tampons is required to remove blood clots.
Tips for chest compressions for pneumothorax:
- close all openings. If there is an inlet, make sure there are outlets as well;
- leave the diagnosis to the doctors; if you are not sure of your diagnosis, you should still apply a dressing;
- When using a non-ventilated occlusive dressing, wait until the patient exhales before applying it;
- When improvising, do not be afraid to wrap the fixation bandage tightly around the patient. Compliance with this recommendation is mandatory;
- If you are using a non-ventilated occlusive dressing and your patient's breathing becomes more labored over time, you can cover the wound with the dressing as he inhales and uncover it as he exhales. This will act similarly to a ventilated bandage.
Overlap zones
For various types of wounds, the following application zones are divided:
- frontal - the human chest itself;
- sublateral – the lateral part of the body in the area of the lungs;
- lateral – the back of the body in the area of the lungs.
Prevention measures
In the treatment of trophic ulcers on the legs, it is important to follow the doctor’s recommendations, which will help reduce local swelling and prevent recurrence of the skin defect. Patients are advised to use compression garments and elastic bandaging of the limb. In severe cases, it is necessary to strictly observe bed rest, use wheelchairs and follow recommendations aimed at maximizing unloading of the limb.
Remember: only a doctor can prescribe treatment if a trophic ulcer develops. You will not be able to choose the right treatment tactics on your own, which greatly increases the risk of developing serious complications.
Overlay algorithm step by step
- Clean and dry the area around the wound as much as possible before applying the dressing to your chest.
- cover the wound with damp, sterile gauze to stop bleeding;
- then cover the gauze and wound with an occlusive dressing and gently press it along the edges to create a strong seal;
- For chest trauma, wait until the patient has exhaled or ask him to cough before applying the dressing. This will reduce the amount of air trapped inside the chest.
You should note that applying an occlusive dressing in the field requires preparation. It is best if you attend specialized courses or master classes and practice the technique on a training mannequin or partner.