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Development of prototype bandage lapper for constant tension bandaging

required for effective medical-clinical treatments

Article  in  Journal of Tissue Viability · April 2012

DOI: 10.1016/j.jtv.2012.04.001 · Source: PubMed

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Journal of Tissue Viability (2012) 21, 54e63

www.elsevier.com/locate/jtv

Basic research

Development of prototype bandage lapper for

constant tension bandaging required for effective
medical-clinical treatments
Someshwar Bhattacharya, Tasnim Shaikh*, Roshan Purushottam Solao

Textile Engg. Department, The Maharaja Sayajirao University of Baroda, Kalabhavan, Vadodara,
Gujarat 390 001, India

KEYWORDS Abstract Application of the bandaging materials is a skilled task and required
Bandage lapper; considerable practice to perform it correctly. The variation in bandaging pressure
Pressure mapper; is introduced due to different tensions applied by different persons during lapping.
Unwinding tension; So, a handy mechanical bandage lapper is developed. This helps in keeping lapping
Crepe bandage tension uniform and adjustable irrespective of the bandager. Its proficiency is
checked by bandaging two persons with different fore-arm circumferential
measures. Bandaging is done at three different limb positions with and without
the use of bandage lapper up to three layers by the same bandager. Three different
lapping tensions viz; 0.40 kgf, 0.45 kgf and 0.50 kgf are set up for bandage lapper to
study their impact on bandage pressure. Pneumatic bandage pressure mapper is
developed for the measurement of bandage pressure. Seven trials separated by
different time intervals are conducted for each variable. This has prevented record
of consistency of bandage pressure measure by chance.
Crepe bandage, normally employed for the management of Oedema in clinical
treatment is used throughout the study. Higher coefficient of variations up to 15%
in pressure values are found when bandaging done without the lapper. However,
identical pressure, coefficient of variation less than 0.3% for all except 0.8% for
bandaging done at 0.45 kgf for second person at position 1, is mapped when
bandaging done with the lapper by the same bandager.
ª 2012 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

Introduction

Bandages are designed to perform a whole variety

of special functions depending upon the type of
* Corresponding author. Tel.: þ91 9725014289.
E-mail addresses: ssb_msu@yahoo.com (S. Bhattacharya), wound and medical requirements. They can be
shaikh_tasnim@yahoo.com (T. Shaikh). woven, knitted, or nonwoven or either elastic or

0965-206X/$36 ª 2012 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.jtv.2012.04.001
Development of prototype bandage lapper
non-elastic. The most common application of
bandage is to hold dressings in place over wounds.
The ability of a bandage to perform this function is
largely determined by accuracy of its lapping [1,7].
The degree of compression produced by any
bandage system over a period of time is deter-
mined by complex interactions between four
principle factors:
➢ The physical structure and elastomeric proper-
ties of the bandage,
➢ The size and shape of the limb to which it is
applied,
➢ The skill and technique of the bandager and
➢ The nature of any physical activity undertaken
by the patient [3,4].
Thus for identical bandage and patient,
compression therapy by means of bandage becomes
extremely effective only by the consistency of
lapping of bandager. It becomes ineffective if
applied too loosely whereas cause pain, could be
intolerable and even harmful if applied too tightly
[5]. Thereby development of portable mechanical
lapping device is thought off. Variations caused due
to person employed can be eliminated by the use of
this device during lapping. Thus helps in achieving
desirable uniform compression. Pneumatic pres-
sure mapper is also fabricated for the measure of
sub-bandage pressure during the study. This paper
describes design features of both the devices and
significance of practical implementation of the
lapper.
Experimental
The first phase of experimental work is related
with the fabrication of bandage lapper and
Figure 1 Bandage lapping instrument.
55
pressure mapping device for the study. The prac-
tical proficiency of the lapper is evaluated exper-
imentally in the second phase.
Materials
Crepe bandage of 6 cm width is used for this study.
It is tested for its physical structural properties,
type of weave, constituent yarn count, thread
density, GSM, thickness. Mechanical properties,
viz; tenacity and percent extension are measured
on Lloyd tensile strength machine working on CRL
method. They are liable to affect its performance
during lapping [5,10]. Test specifications used for
tensile testing are as follows:
➢ Cross head speed ¼ 50 mm/min
➢ Gauge length ¼ 20 mm
➢ Strip width ¼ 25 mm
Comfort associated air permeability value is
measured at 10 mm water level pressure on
Metefem air permeability tester.
Methods
Bandage lapper
The main principle of bandage lapping instrument
is to maintain uniform bandage tension during
lapping over a body.
Design features of bandage lapper
The design features of the bandage lapper are
illustrated in Fig. 1. Rectangular aluminium body
(12 cm  6 cm) is used for bandage lapping
instrument. This shape and light weight of
aluminium has provided ease of gripping of lapper
by hands during lapping. Dimensions of the
56
rectangle are chosen in accordance to the sizes of
support bandage normally used for the manage-
ment of oedema in clinical treatment.
Instrument is composed off totally three rollers,
two rubber coated top rollers (each of 15 mm Ø)
and one aluminium bottom roll (5 mm Ø). They all
are fitted on the bearing for their free rotation
around their axis. Bushes of the first top roller are
fixed with side wall but bushes of the second roll
are fitted in the slotted bracket. Thus second
roller is capable of making lateral displacement
with respect to first one. This helps in setting the
nip pressure as per the unwinding tension in the
bandage required during lapping. The setting is
done with the help of two spiral spring loaded set
screws, [Fig. 1]. Half of the spring is passed
through the groove of aluminium slot. This
prevents deflection of spring when tension is
increased with the help of screw. Bottom roller is
removable and used as spindle for winding
bandage on it. It is secured into the slot of adapter
by the holding screw during lapping.
Arrangement for setting unwinding tension for
bandage lapping
Fixed measuring scales, one on each side, cali-
brated in millimetre are used initially [Fig. 1].
They define linear displacement in screw position
with reference to the nip pressure applied
to bandage unwinding. The interrelationship
between linear displacement of screws and
bandage unwinding tension is established by con-
ducting pilot trials. For each unit displacement of
screws the unwinding bandage tension is measured
on Lloyd tensile tester [Fig. 2]. Average of five
consecutive test readings is used for the final
calibration of measuring scale in terms of bandage
unwinding tension in kgf.
Figure 2 Lloyd tensile strength tester set up used for
the unwinding tension measurement of bandage during
lapping.
S. Bhattacharya et al.
Bandage passage through lapper
Bandage is wound on the bottom roller. Top rollers
are set to desired unwinding tension with the help
of set screws. Then bandage is passed through the
nip of the top rollers for lapping as per shown in
Fig. 3.
Bandage pressure mapping device
Photograph of bandage pressure mapper devel-
oped and used for the present study is shown in
Fig. 4(aeb). It works on the same working principle
of blood pressure measuring device. Bandage
pressure is related to the pressure changes in the
fluid on the application of an external pressure.
Thus bandage pressure measured by this device is
reported in terms of mmHg as Mercury is used as
fluid in manometer. Its selection is based on its
favourable properties like non stickiness on glass
surface and faster reversal to the original position
on the release of pressure due to its higher density
as compared to other fluids used during pilot trial
experimentations, viz; water, kerosene. This has
permitted the measure of wide range of bandage
pressure within small size manometer more accu-
rately. The accuracy level of pressure measure-
ment recorded for selected crepe bandage during
pilot trials was 0.0125% based on 50 readings at
99% confidence level.
Experimental set up is composed off manom-
eter, compressor, air valves, silicon tubes and
sensor. A small rubber balloon in flatten at fixed
pressure is used as rubber diaphragm. It serves as
a sensor during bandage pressure measurement.
Compressor is having air inlet valve connected to
the manometer with the help of silicon tube.
Second end of manometer is connected with the
sensor (rubber diaphragm) via two way control
valve.
Figure 3 Passage of bandage through lapping
instrument.
Development of prototype bandage lapper
Figure 4 (a) Photograph of bandage pressure mapper. (b) Schematic diagram of bandage pressure mapper.
Calibration
The rubber balloon is in flatten with fixed
compressed air and attached with silicon tube.
Both the valves are kept closed. End of the balloon
is wrapped well by the adhesive tape over the
silicone tube to prevent leakage of air. Balloon air
is then allowed to pass through manometer by
opening the two way valve. The change in
manometer pressure is calibrated with the help of
air inlet valve of the compressor.
Balloon size is optimized for attaining accuracy
of measure without uncomforting to the patient
during lapping in pilot trials. The fixed in flattening
air pressure of the balloon decided experimentally
is 0.1758 kg/cm2. It is used throughout the
57
experimentation to calibrate the instrument
against this preferable size of in flat balloon.
Bandage pressure measurement
After calibration of pressure mapper, sensor end of
silicon tube is fixed with adhesive tape on the
desired limb position [Fig. 5(a)]. Both the valves
are kept open during measurement. Bandage is
wrapped with bandage lapper at constant
unwinding tension [Fig. 5(b)]. This exerts external
pressure on the sensor kept underneath the
bandage and changes manometer pressure.
Change is read off directly from the fixed scale as
a pressure in respected unit of fluid used in the
manometer, viz; mmHg. The same way bandage
58 S. Bhattacharya et al.

Figure 5 Bandage pressure measurement.

Bandaging is done with and without the lapping

Table 1 Circumferences of fore-arm.
apparatus by the same bandager. Three lapping
Person Circumference of fore-arm (mm) tensions normally practiced in bandaging, viz;
Position 1 Position 2 Position 3 0.40 kgf (67 g/cm), 0.45 kgf (75 g/cm) and 0.50 kgf
1 185 210 250 (83 g/cm) are set for each person on lapper [4];
2 160 190 215 (Steve et al, 2003). However such accurate lapping
tension setting is not possible for the classical
mode of bandaging. So, it is done as per normal
manual bandaging process without consciously
changing unwinding tension. Lapping is done at
three different limb positions just below the wrist
and elbow (Fig. 6) up to three layers. Bandage
pressure in each case is measured with newly
designed pressure mapper. Seven readings spread
over different time intervals, viz; 0 min, 15 min,
1 h, 4 h, 12 h, 1 day and one week. Time factor
considered to check significance of consistency of
lapping arises is not due to the chance in each
case.
Figure 6 Fore-arm (Anterior side).

Results and discussion

pressure is mapped for bandaging done without
lapper.
Specifications of crepe bandage fabric used for the
Two persons with different circumferential
study are reported in Table 2. Bandage pressure
measure of fore-arm (Table 1) are considered for
mapped for three layers laid with and without
the study.
lapper for two persons at three limb positions

Table 2 Specifications of crepe bandage sample.

Bandage Width Weave Fabric sett Count (tex) Thickness Mechanical properties
properties (mm) Warp Weft Warp Weft (mm) Tenacity (g/tex) Extension (%)
EPCM PPCM Warp Weft Warp Weft
1. 60 Plain 19 25 24.6/2 66.7 0.93 1640.4 818.3 406.1 69.7
Development of prototype bandage lapper 59

Figure 7 (a) Bandage pressure measurement for person 1 at limb position 1. (b) Bandage pressure measurement for
person 2 at limb position 1.
60 S. Bhattacharya et al.

Figure 8 (a) Bandage pressure measurement for person 1 at limb position 2. (b) Bandage pressure measurement for
person 2 at limb position 2.
Development of prototype bandage lapper 61

Figure 9 (a) Bandage pressure measurement for person 1 at limb position 3. (b) Bandage pressure measurement for
person 2 at limb position 3.
62
are reported graphically in Figs. 7e9(aeb)
respectively.
Bandage pressure measured for IInd person is
higher as compared to the Ist Person at all the
lapping tensions and layers under consideration
[Figs. 7e9(aeb)]. This is mainly attributed to the
presence of stiffer bonny structure than flexible
muscular species at the limb with lower circum-
ferential measure (Table 1). This has not
permitted compression under applied lapping
force. This has also gone in agreement with Lap-
lace law [4,6e10]. As per this law the pressure
exerted by the bandage depends on the fabric, the
elastomeric characteristics of the bandage, on the
tension applied, the number of overlapped layers
and the anatomical characteristics (size and
shape) of the limb being bandaged. The quantity
of the interaction of these events is expressed by
the Laplace law (Equation (1)). The applied pres-
sure (P) will be directly proportional to the tension
(T ) of the elastic material and the number (n) of
spires applied, while it will be inversely propor-
tional to the radius (r) of the compressed surface
and the width (h) of the bandage. Thus going in
accordance to the Laplace law, the decreased in
pressure is found with the increase in radius of the
limb for IInd person to Ist person for identical
conditions of bandaging.
Laplace law P ¼ Tn=rh ð1Þ
where P ¼ pressure exerted on the skin,
T ¼ tension applied to the bandage, n ¼ number of
spires applied, r ¼ radius of compressed area,
h ¼ bandage width.
Similarly the drop in the bandage pressure,
while shifting mapping point from 1st limb position
to the 3rd limb position (Fig. 6), has also attributed
to increase in limb size (r) for both the persons
(Table 1).
Going in agreement with [9], at identical
bandage tension (T ), radius of limb (r) and
bandage width (h), bandage interface pressure (P)
recorded is higher with the increase in spirals/
layers (n), in all the cases [Figs. 7e9(aeb)].
The inclination in the bandage pressure mapped
with the increase in lapping tension (T ) used for
lapper unit for both the persons at all three limb
positions. It has also proven agreement to Laplace
law. This feature of mechanical lapper can facili-
tate in bandaging at high compression level or low
compression level [2] as per the need of medicinal
treatment.
Almost identical quantum of pressure (% Coef-
ficient of variation less than 0.3% for all except
0.8% for IInd person at 45 kgf tension) is mapped at
S. Bhattacharya et al.
different time intervals in each case for bandaging
done with lapper by the same bandager. But the
marked fluctuation in bandage pressure starting
from 9% up to 15% is found in classical mode of
bandaging in each case, although done by the
same bandager [Figs. 7e9(aeb)]. This is mainly
attributed to the subjective mode of controlling
lapping tension in classical mode, viz; manual
judgement. Thereby variations caused in lapping
tension (T ) have made bandage interface pressure
(P) to vary. Whereas, instrumental bandaging has
a provision to set and control uniform lapping
tension. Thereby it has helped in nullified human
error irrespective of time and operator during
bandaging. Thus it is not exaggerating to mention
that instrumental lapping permits uniformity of
bandaging at different pressure level as per the
need of medicinal treatment over a period of time.
Conclusion
A pressure bandage can hold the cotton close to
the wound and apply pressure, to stop the
bleeding and allow blood to begin clotting. The
effectiveness of compression bandaging depends
upon the degree of pressure provided and, this in
turn, is determined by a number of factors
including the physical and elastomeric properties
of the fabric, the size and shape of the limb, the
skill or technique of the operator and, most
importantly, the tension produced in the bandage
fabric during the application process. The tension
developed in most flat bandages during application
is determined entirely by the operator. Studies
have shown that the tension with which bandages
are applied by different nurses varies significantly
from person to person. So, a portable bandage
lapper is developed with the provision of setting
lapping tension. Experiments done with two
persons with different circumferential measure
have proven the proficiency of this device in
attaining constant pressure bandaging with crepe
bandage. The coefficient of variation recorded for
bandage pressure at different tension level with
lapper is less than 0.3% for all cases except 0.8%
for 45 kgf tension level for IInd person. However it
is less than 1% for all. The coefficient of variation
recorded is ranging between 9 and 15% for classical
mode. Thus the pressure achieved by same band-
ager on the repeated application of a bandage
with lapping apparatus is much more consistent
than the classical mode.
The effectiveness of instrumental application of
compression bandage is checked successfully for
different size and shape of limbs, number of spirals
 Development of prototype bandage lapper
and bandage tension. The pneumatic bandage
pressure mapper is developed and used for the
study. The results obtained for each variable have
shown good agreement with Laplace law.
Conflict of interest statement
There is no conflict of interest among us as well as
any organization or employer. This is solely based
on our own basic research work done in the
direction of product development in the field of
medical textiles.
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