BANDAGES –

SURGICAL WRAPPING
Asist. Univ. Dr. Corina Popoviciu
corina.popoviciu@umfcd.ro
 BANDAGE = piece of material used to keep in
place a dressing
• Roles:
• Keeps in place a dressing or a splint
• Supports or limits the movements of an affected extremity
• Elastic bandages reduce swelling – for varicose veins or sprained ankle
• Create a bloodless field for reconstructive procedures
• They roll ☺ so we unroll them
• Esmarch bandage/tourniquet = soft rubber bandage, used to
exsanguinate the limb before surgery – limb is kept elevated, start
bandaging from distal to proximal (arm or thigh), then unroll the
bandage from fingers/toes
• In place for maximum 1 h!
GENERAL PRINCIPLES: DRESSING AND BANDAGE
• Wash hands – before and after the dressing.
• Wear gloves where necessary (unsterile to remove the old dressing;
sterile gloves or clamp while performing the new one)
• Face the patient when performing the bandage (to follow his expression)
– except while bandaging the head
• Put the patient in a comfortable position – lying or sitting.
• Explain your movements, be as gentle as possible, don’t cause
unnecessary pain.
• Remember the patient is often scared, not knowing what to expect.
• Select gauze of suitable material (cotton), proper size and number.
• Avoid elastic bandages in traumatic cases when swelling is expected
(wounds, crush syndrom...)
GENERAL PRINCIPLES: DRESSING AND BANDAGE
• Support the injured area while bandaging (get help) and
keep it elevated
• Usually, bandage starts distally, progressing upward,
following the venous return
• Hold the bandage with the roll uppermost, unrolling a
few centimeters of the bandage at a time.
• Unrolling
• from left → right
• from below → upward
• from within → outward
• from distal → proximal
• Do not bandage too tight or too loose.
• Separate fingers & toes with gauze, to prevent
maceration
• If a joint is involved, flex it slightly.
 BANDAGE TECHNIQUE
• Hold the end of the bandage and wind
it around the part twice to fix it.
• While dressing an extremity use
oblique turns, to keep the dressings in
position.
• Superpose partially the turns (cover ⅔
of one turn by the next one)
• Finish with a circular turn
 BANDAGE TECHNIQUE
• Fix the end with adhesive tape or split the
terminal portion longitudinally and tie the 2
ends around the extremity
• When fingers/toes are bandaged together,
separate them with gauze
• If possible, leave fingers & toes exposed to
check circulation.
• Observe the bandaged extremities carefully for
any signs of swelling, cyanosis or pallor due to a
bandage that is too tight (interference with
circulation – stasis or ischemia)
BANDAGE TYPES: UNROLLING THE BANDAGE

• Circular: cylindrical regions → turns overlap

completely

• Spiral: tronconic/limbs → turns overlap partially

(½,⅔)

• Figure eight (“8 figure”) → turns climb diagonally,

encircle the upper region and then descend,
encircle the lower region, then climb again
 BANDAGE TYPES: UNROLLING THE BANDAGE

1 2 • Reverse turns: after a circular turn, block

the gauze using the thumb, then change
direction

E.g. Recurrent turns for covering the skull:

2 4
1 3
after a circular, occipital→frontal turn,
block the bandage, reverse direction from
anterior→posterior, repeat changing from
posterior →anterior
BANDAGE TYPES: UNROLLING THE BANDAGE

• Fan: elbow, knee → start distally with circular

turns, climb with spiral turns, covering the
joint, end with circular turns. So, medial
turns/laps are closer, lateral ones are
distanced/further apart

• Turtle: elbow, knee → start circular over the

elbow or knee, covering the joint, then with
”8-figure” turns cover ½ of the forearm and
arm, final shape of a turtle shell
 BANDAGE TYPES: UNROLLING THE BANDAGE
• Spica (wheat ear/spike): 8-figure turns, at a joint level, each
turn partially covering the previous one (½ -⅔), to form the
spica => e.g. for thumb or foot

• When the tip must be dressed, start distally with 1-2

recurrent turns, then a circular one, followed by the 8-turns
2

1
CIRCULAR TURNS
SPIRAL TURNS
8 FIGURE BANDAGE
RECURRENT TURNS
FAN BANDAGE
TURTLE BANDAGE
SPICA (EAR OF WHEAT)
HEAD BANDAGE
Focus on the bigger picture, not the head!
Look at the bandage, not the face!
THE BONNET (capelina)

1 bandage, 2 persons (doctor + patient or

nurse)
1. Circular turns around the head
2. Front → recurrent to the occiput
3. Recurrent from back to front
4. Repeat 2-3 times, fan-like, until covering
the hole skull
5. Finish with circular turns, that immobilize
the anterior-posterior turns
 The BONNET (capelina)
1. Circular turn around head (horizontal fronto-occipital turn) 2. Front → recurrent to the occiput

3. Recurrent from back to front 4. Repeat, fan-like 5. Cover skull, end circular
HIPPOCRATE’S MITRE/MITER

2 bandages, 2 persons, recurrent type

• I-st bandage: circular turns around the
head, from occiput to the front
• 2-nd bandage: anterior→posterior
(frontal→occiput) turns
• In front, then in the back, alternatively,
bandages cross, with the first going
around the head, and the second from
anterior→posterior
NOSE & CHIN BANDAGE (THE SLING)
THE BRIDLE

1. Circular turn from occiput→to frontal

and back
2. Descend behind the ear and cover the
chin
3. Go up to the temporal region
4. Ascend in front of the ear
5. From occiput descend in front of the
ear
6. Cover again the chin
7. Go to the occiput below the ear
8. Finish with circular turn
 THE BRIDLE
1. Occipito-frontal 2. Descend behind ear 3. Go up to the 4. Ascend in front
turn and cover the chin temporal region of the ear

5. Turn to the other 6. Cover again the chin 7. Go below the ear 8. Repeat
side, in front of the ear
MONOCLE & BINOCULAR BANDAGE
• RIGHT
• Fronto-occipital circular turn
• Occiput → under right ear → cover right
eye
• Repeat
• Finish with circular turns
• LEFT
• Fronto-occipital circular turn
• Cover the right eye as above
• From frontal right descend over the left
orbit
• Below the left ear, climb → occiput
• Repeat
• Finish with circular turns
 MONOCLE BINOCULAR
N.B. You can either go from occipital under the opposite ear
and climb to cover the eye or you can descend from frontal
over the affected eye and go below the opposite ear

2. From occiput, go below right

ear and cover the right eye
3. Repeat, partially
1. Circular frontal-occipital turn overlapping turns
ARM & HAND BANDAGES
SHOULDER SPICA

• Start in deltoid region

• Transversal turn on the back → opposite axilla
• Cross on anterior thorax → descend over the
shoulder → go around the arm
• Climb over the shoulder, transverse on the back →
opposite axilla → transverse on anterior thorax,
descend over the shoulder, surrounding the arm
• Repeat
• Form the spike while ascending each turn to
overlap ½-⅔ of the previous one
 1. Start in left
deltoid region

SHOULDER SPICA

4. Climb over the

shoulder, go on the back
and through right axilla. 5. Spica is formed
3. Anterior turn, Transversal turn on overlapping the
over the left anterior thorax, over the figure 8 turns (½-⅔)
2. Transversal turn on shoulder, descend shoulder, back of the arm,
the back towards over the arm, surrounding it again.
opposite axilla surrounding it
8-FIGURE BANDAGE (CLAVICLE) WATSON-JONES

• Keeps the back in hyper-extension, lifting the

shoulders, immobilizing clavicles
• Vertical circular turn around the right
shoulder
• From right axilla, ascend behind the neck,
descend toward the opposite axilla
• Climb over the left clavicle
• Descend towards the right axilla
• Climb in front of the right clavicle, descend on
the back to the left axilla
• Climb in front of the left clavicle, descend on
the back to the right axilla etc
• Superposed 8 figure turns
8-FIGURE BANDAGE (CLAVICLE) WATSON-JONES
2. From the right axilla,
climb over the right scapula,
towards the left shoulder,
descend over the left
clavicle
1. Vertical circular turn
around the right
shoulder
Or the figure 8 turn climbs in
front of the right clavicle,
3. Surrounding the left descends on the back to the
axilla, go over the left left axilla, goes in front of the
scapula, towards right left clavicle, descends on the
shoulder, descend over back to the right axilla
the clavicle to the axilla
 DESSAULT BANDAGE
IMMOBILIZE THE HUMERUS, SHOULDER, CLAVICLE,
ELBOW
• 3 TYPES OF TURNS: CIRCULAR,
VERTICAL AND OBLIQUE
I. CIRCULAR, AROUND THE
THORAX, IMMOBILIZING THE
ARM AND FOREARM AGAINST
THE CHEST
II. VERTICAL, AROUND THE
SHOULDER AND ELBOW
III. OBLIQUE, CONNECTING
OPPOSITE AXILA TO THE
INJURED SHOULDER
 DESSAULT BANDAGE
IMMOBILIZE THE HUMERUS, SHOULDER, CLAVICLE,
ELBOW

1. Circular turns around the thorax,

covering it from epigastric region to axilla
• Cotton gauze pads in the axilla
• Attention so the thorax circular turns do
not interfere with respiration (if too tight)
• NOT SUITABLE FOR FRACTURED RIBS, as it
limits the thoracic expansions
• Place the forearm on the epigastric region
2. Horizontal turn, over the forearm,
immobilizing it to the thorax
 DESSAULT BANDAGE
IMMOBILIZE THE HUMERUS, SHOULDER, CLAVICLE,
ELBOW

3. From the opposite axilla, go

oblique/diagonally toward the affected
shoulder
4. Descend vertically, on the front, to the
elbow
5. Surrounding the elbow, climb vertically,
on the back, to the shoulder
6. Go diagonally to the opposite axilla on
the front
7. Circular turn over the arm and forearm
Repeat 3 → 7
 DESSAULT BANDAGE
IMMOBILIZE THE HUMERUS, SHOULDER, CLAVICLE, ELBOW
3. From opposite 6. Oblique
4. Descend from 5. Around the
axilla, posterior turn from the
the shoulder to elbow, climb to the
1. Horizontal circular turn, oblique to shoulder to
the elbow shoulder
turns on the thorax the affected opposite axilla
(vertical anterior) (vertical posterior)
shoulder

2. Horizontal
turns,
immobilizing the
arm and forearm 7. Horizontal turn over
against the arm, forearm and
thorax thorax. Repeat!
ELBOW BANDAGE*

• FAN:
• Start distally, on the forearm, with spiral turns
• Cover the elbow
• Finish with circular turns around the arm

• TURTLE:
• Cover the joint with circular turns to fixate the
dressing
• 8-figure turns over the arm and forearm
• Each turn slightly larger than the previous one
• Finish with circular turn on the arm

* See also the knee bandage

THUMB SPICA
• Spica is formed on the dorsal aspect of the thumb,
with 8-figure turns
• If the thumb must be dressed, start with recurrent
turns over its tip, followed by a circular turn, then
form the spica:
• descend dorsally from the ulnar border of the thumb to
the radial wrist,
• encircle it on the volar aspect,
• then climb dorsally from the ulnar border of the wrist to
the radial border of the thumb,
• go around the thumb
• repeat
• Repeat the 8 figure turns around wrist and thumb,
each turn more proximal as the previous
• Finish with circular turn around the wrist
• Bandage can start with circular turns around the
wrist
THUMB SPICA
DORSAL HAND SPICA
• Start with circular turn(s) around the wrist
• When possible, fingertips should be left undressed,
to monitor circulation
• If fingers have lesions, or if the entire hand must be
covered, fingers must be separated with sterile dry
compresses to prevent maceration.
• The bandage should cover first the fingers (start
from distal, with recurrent turns)
• Each figure 8 turn:
• ascending dorsally from the ulnar border to the fingers,
between thumb and index,
• goes around the fingers (volar)
• then descending on dorsal aspect to radial border of the
wrist
• goes around the wrist (volar)
• Repeat turns, each more proximal than the previous
one, to form the spica
VOLAR HAND SPICA
• Less used as the dorsal one
• The thumb is the central point
• Start with circular turn(s) around the wrist
• Then 8 figure turns:
• from the radial border the wrist, near the base of
the thumb on the volar aspect toward the ulnar
border of the hand
• around the fingers on the dorsal aspect
• descend from the radial border of the index, on the
volar side toward the ulnar border of the wrist
• around the dorsal aspect of the wrist
• Repeat, each turn going more proximal or distal than
the precedent one
• Close with circular turn around the wrist
THE GLOVE
• Each finger is dressed separately
• Used when independent movement of the
fingers is desired and the fingers need a
dressing (e.g. after burns)
• Quite demanding, so if not mandatory, use
a whole hand bandage
THE GLOVE
FOOT & LEG BANDAGES
 INGHINAL SPICA
• LEFT
*SIAS => ASIS anterior superior iliac spine
• RIGHT
• Circular turn around the abdomen
• From anterior superior iliac spine,
descend oblique in front of femoral
region → internal face of right thigh →
• Around the thigh → external border of
thigh → upward to opposite ASIS → on
the back toward the right ASIS
• If 1 side – repeat
• If both side need dressing → left spica
• Descend from the right ASIS, toward the
exterior border of left thigh → around →
interior face of the left thigh →
• Ascend toward the left ASIS →
• Around abdomen on the back →
• Right ASIS → descend toward the
external face of the left tight
• Repeat
 INGHINAL SPICA
2. From ASIS, descend oblique 3. Circular turn 4. Upward to
1. Circular turn around
the abdomen in front of femoral region → around the thigh opposite ASIS
internal face of right thigh

5. Around the abdomen 7. From interior to exterior, 8. Upward to

6. Descend from ASIS around the thigh
(on the back) opposite ASIS
 KNEE BANDAGE: FAN
1. Start distally on the leg/calf, 2. Cover the knee 3. Finish with circular turns around
with spiral turns the thigh

*You can also start proximal, on the thigh, as in the picture

 KNEE BANDAGE: TURTLE
1. Cover the joint with circular turns 2. 8-figure turns over the leg 3. Finish with circular turn
to fixate the dressing and thigh* on the thigh

*Each turn slightly larger than the previous one

ANKLE DRESSING - TURTLE

• Keep the foot elevated 1-2 minutes, to

prevent venous stasis
• 8-figure turns around the foot and the
calf
• cover the ankle
• medial border of the foot → up toward
lateral aspect of the calf
• turn around the calf
• descend from the medial face of the calf
→ to lateral border of the foot
• Repeat, slightly superposing each turn
over the previous one
• Finish with circular turns around the calf
TIBIO-TARSIAN SPICA

• Keep the foot elevated 1-2 minutes,

to prevent venous stasis
• Remember the dorsal hand spica
• Circular turns around the tibio-tarsal
joint
• 8 figure turns crossing on the dorsal
face of the foot
• If fingers included in the dressing,
remember to separate them with dry
compresses (not too thick, though)
 TIBIO-TARSIAN SPICA

1. Circular turns around the 2. 8 figure turns crossing on 3. Form the spica, end at the calf
tibio-tarsal joint the dorsal aspect of the foot
THANK YOU FOR YOUR ATTENTION!
corina.popoviciu@umfcd.ro