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Types of Bandages — A Comprehensive Guide

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1. Classification by Material & Construction

A. Gauze (Cotton/Cellulose) Bandages

• Plain gauze — used for packing, padding, or as secondary layers
• Impregnated gauze — infused with petrolatum (e.g. Vaseline® gauze, Adaptic™), soft paraffin wax, or antimicrobials (povidone-iodine, silver sulfadiazine, chlorhexidine). These are less adherent, can be molded into wound depressions, and are less painful on removal. Disadvantage: risk of maceration if left on too long.

— Dermatology 2-Volume Set 5e, p. 2961

B. Roller Bandages

• Cotton crepe — conforming, slightly elastic, used for retention and light compression
• Elasticated (stretch) bandages — conform well to body contours, used for compression and support
• Cohesive/self-adherent (e.g. Coban™) — sticks to itself without adhesive, used for securing dressings, particularly over joints or digits; can cause skin tears if directly applied to intact skin

C. Tubular Bandages

• Retention bandages post-dressing
• Digit protection (e.g. tubular gauze for finger wounds)

Warning: Tubular gauze over a finger wound should not be applied in more than two layers or twisted between layers — this can produce a tight bandage causing ischemic damage to the digit. — Tintinalli's Emergency Medicine, p. 335

D. Triangular Bandages

E. Adhesive Bandages (Plasters)

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2. Classification by Function

A. Retention/Securing Bandages

B. Compression Bandages

1. Long-stretch (elastic) bandages — provide resting and working pressure; maintain compression both at rest and during movement. Examples: elastic crepe, four-layer bandage system.
2. Short-stretch (inelastic) bandages — provide high working pressure during muscle contraction but low resting pressure. Examples: Unna's boot. Preferred for arterial or mixed venous/arterial disease due to lower resting pressure risk.
3. Multi-layer compression bandage systems — combine several layers (e.g. wool, crepe, elastic, cohesive) to achieve sustained, graduated pressure. The four-layer bandage is the gold standard for venous ulcer management.

— Dermatology 2-Volume Set 5e; Mulholland & Greenfield's Surgery 7e

Compression Classes (by pressure at ankle):

C. Immobilization Bandages

• Sling-and-swathe — used after shoulder dislocation reduction, humeral fractures, and elbow injuries. A sling supports the arm; a swathe (binder) wraps around the body to immobilize it against the chest.
• Velpeau bandage — a specific sling-swathe configuration holding the arm in adduction and internal rotation.
• Figure-of-eight bandage — traditionally used for clavicle fractures; no longer recommended as it is uncomfortable and provides no additional benefit over a simple sling.

— Rosen's Emergency Medicine; Rockwood & Green's Fractures in Adults 10e

D. Pressure Bandages

E. Protective/Non-adherent Dressings

• Low-adherent dressings (e.g. Melolin, Telfa) — reduce pain on removal
• Semi-permeable film dressings (e.g. Tegaderm, Op-Site) — transparent, allow oxygen exchange, maintain moist environment, used on superficial/incisional wounds

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3. Advanced/Specialty Bandages (Wound Dressing Categories)

— Pfenninger & Fowler's Procedures for Primary Care, 3e, p. 312

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4. Bandage Selection by Wound Type

— Pfenninger & Fowler's Procedures for Primary Care, 3e, Table 44-5

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5. Key Principles in Bandage Application

• Never apply too tightly: Circulatory compromise and compartment syndrome are serious risks — especially with circumferential casts and tubular gauze on digits.
• Protect intact skin: Adhesives cause maceration; use skin protectants (zinc oxide, A&E ointment) on skin chronically exposed to moisture or tape.
• Match dressing to wound stage: Wound character evolves — what is appropriate in the inflammatory phase differs from the granulation and epithelialization phases.
• Elevation: After dressing, elevate the injured extremity above heart level for the first 24 hours to reduce edema.
• Bandage contact lenses: A specialized application — soft therapeutic lenses used as bandages for corneal abrasions, providing pain relief and promoting epithelial healing.

— Roberts & Hedges' Clinical Procedures in Emergency Medicine; Tintinalli's Emergency Medicine

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Quick Reference Summary

Types of Bandages — Quick Reference

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🔵 1. By MATERIAL

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🟢 2. By FUNCTION

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🟡 3. Compression — The 3 Types

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🔴 4. Advanced Wound Dressings

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⚡ Memory Trick

"MFW — Material → Function → Wound type" Pick material first → decide its function → match it to the wound

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🚨 3 Rules Never to Forget

1. Never too tight → causes ischemia
2. Moist environment heals faster than dry
3. Change dressing type as the wound heals — one size does NOT fit all

Types of Bandages — 8 Marks Answer

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Definition

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Types of Bandages

1. Gauze Bandage

• Made of cotton + cellulose acetate
• Inexpensive, widely available
• Disadvantage: May adhere to wound; limited moisture retention
• Used as: retention layer, wound packing
• Can be impregnated with petrolatum (Vaseline gauze) or antimicrobials (povidone-iodine, silver) to reduce adherence

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2. Roller Bandage

• Long strip wound into a roll
• Applied in overlapping turns around body part
• Subtypes:
  • Cotton crepe — light compression, retention
  • Elastic/stretch — conforms to body contours
  • Cohesive (Coban) — self-adherent, no adhesive to skin

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3. Triangular Bandage

• Large triangular cloth
• Used as arm sling, head bandage, or folded for splint padding
• Versatile, especially in first aid and emergency settings

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4. Tubular Bandage

• Seamless tube applied over limbs or digits
• Used for retention and digit protection
• ⚠️ Must not exceed two layers on a finger — risk of ischemic injury

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5. Adhesive Bandage (Plaster)

• Small absorbent pad on adhesive strip
• Used for minor wounds and abrasions
• Repeated use may cause skin tears or maceration

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6. Compression Bandage

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7. Immobilization Bandage

• Sling-and-swathe — shoulder dislocation, humeral fractures
• Velpeau bandage — arm held in adduction + internal rotation
• Figure-of-eight — historically for clavicle fractures (no longer recommended)

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8. Advanced/Specialty Dressings

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Dressing Selection by Wound Type

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Key Principles (Important for Marks)

1. Moist wound environment heals 30% faster than dry (George Winter, 1962)
2. Never apply too tightly → risk of ischemia and compartment syndrome
3. Change dressing type as wound progresses through healing stages
4. Protect intact skin from adhesives → use zinc oxide or skin protectants
5. Elevate limb for first 24 hours to reduce edema post-dressing

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Conclusion

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Surgical Needles & Needle Holders — Deep Answer

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PART 1: SURGICAL NEEDLES

Definition

"Inappropriate needle selection can damage the tissues, causing poor results and delayed healing." — Pfenninger & Fowler's Procedures for Primary Care, 3e

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Anatomy of a Surgical Needle

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1. Types of Eye (Suture Attachment)

"Needles have been almost exclusively swaged because threaded needles have many undesirable characteristics." — Pfenninger & Fowler's, p. 200

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2. Types by Needle Point

A. Cutting Needles — for tough, dense tissue

• Triangular cross-section
• Cutting edge on the inner (concave) curvature
• Force concentrates at the apex → tendency to cut/tear toward the wound edge
• Rarely used today due to this disadvantage

• Cutting edge on the outer (convex) curvature
• Flat inner surface distributes suture tension across the base → less risk of tissue tear
• Used for: skin, fascia, tendon sheaths
• Unless specified otherwise, "cutting needle" = reverse cutting

• Flat on top and bottom, cutting side edges
• Used in: ophthalmic surgery — allows needle to travel in plane of tissue layers

B. Tapered (Round) Needles — for soft, delicate tissue

• Round/oval body, tapers to a sharp point without cutting edges
• Creates a small, clean hole by pushing tissue aside without cutting
• Used for: bowel, blood vessels, peritoneum, nerve repair
• A cutting needle would never be used in bowel anastomosis — risk of leakage

C. Blunt-Point Needles

• Round body, blunt tip that dissects without cutting
• Used for: friable parenchymal tissue — liver, kidney
• Also used in obstetrics to reduce needlestick injuries

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3. Types by Body Shape (Curvature)

"In general, a 3/8-inch curvature is adequate for most cutaneous procedures." — Pfenninger & Fowler's, p. 201

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4. Needle Size Selection

• Larger needle → deeply buried sutures, thick tissue
• Smaller needle → thin skin layers, facial closures
• Facial closure: P-3 needle (precision cosmetic)
• Thick skin (trunk, extremities): FS-2, FS-3 needles (for skin)

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5. Complications of Needles

"When a needle bends during suturing, the act of straightening it further weakens the metal." — Pfenninger & Fowler's, p. 201

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PART 2: NEEDLE HOLDERS

Definition

"A hemostat or other grasping instrument is not an acceptable substitute for a needle holder when suturing. The needle will easily roll out of position because it requires a flat surface to maintain its operative position." — Pfenninger & Fowler's, p. 200

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Anatomy

• Jaws — grasp the needle (serrated or smooth)
• Box joint — pivot mechanism
• Ratchet lock — locks jaws at required tension
• Ring handles — for finger placement and control

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Types of Needle Holders

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Jaw Types Compared

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Correct Technique for Holding the Needle

1. Grasp the needle at the junction of the posterior one-third and middle one-third of its body — one needle-holder's width past the curved center
2. Never grasp the shank — it is the thinnest, weakest part and will bend
3. Apply only one to two clicks of the ratchet — excessive pressure weakens the needle
4. Advance force in the direction of the needle's curvature (pronate/supinate wrist)
5. The tip of the needle holder should just cover the needle

"The needle should be grasped below the shank portion, but beyond the mid-body region. The tip of the needle holder should just cover the needle, and the handle should be closed only to the first or second ratchet." — Pfenninger & Fowler's, p. 200

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Matching Needle Holder to Surgery Site

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Key Rules — Needle Holders

1. Never use a hemostat as a substitute — needle rolls out of position
2. Gold handles = tungsten carbide inserts = superior quality
3. Serrated holders for large needles in thick skin; smooth holders for fine needles on face
4. Do not use large needles with fine holders — damages the inserts
5. Olsen-Hegar is convenient but easy to accidentally cut the suture when regripping

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Summary Table

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Sources: Pfenninger & Fowler's Procedures for Primary Care, 3e | Roberts & Hedges' Clinical Procedures in Emergency Medicine | Dermatology 2-Volume Set 5e