7

Material and construction parameters

7.1 Introduction
Compression therapy is the most assuring treatment given to heal venous ulcers
and other chronic venous diseases [1–3]. The efficacy of the compression
treatment is undoubtedly dependent on the interface pressure developed in the
interface between the bandage and skin and also on the holding capacity of
the bandage to sustain a uniform interface pressure gradient over the limb for
faster recovery [4–11]. The knowledge of interface pressure profile generated
by a compression bandage over time is of prime importance as it would
help to know after how much time the bandage loses its efficacy and needs
rewrapping or replacement for the further compression treatment. Work done
to understand the effect of different material types and structure of bandage
fabrics on the interface pressure profile generated by the compression bandage
over time is discussed in this chapter.
The efficiency of different bandages to provide sustained pressure varies
because of the differences in their structure and constituent material type. Bandage
applies pressure over the limb because of the internal stress developed in the
structure during its application over limb by applying external force [12–13].
The capacity of a bandage to sustain pressure is greatly dependent on its ability
to maintain this internal stress developed in the bandage under wrapped position.
Bandages consist of fibrous materials which are viscoelastic in nature. Because
of the viscoelastic behavior of the fiber or yarn, the stress developed in the textile
structure under constant extension decreases over time. In the previous chapter
this fact has been demonstrated and it has been found that the reduction of the
internal stress in the bandage over time is an important factor for the pressure
drop during the course of compression treatment. Ability of a bandage to hold the
internal stress depends on the fiber type, yarn structure and the woven or knitted
structural features of the bandage [14–29]. It has been found that different fibers
behave differently under stressed condition. Cotton and viscose fibers have been
found to have higher stress relaxation as compared to synthetic fibers like nylon,
PET etc. Understanding relaxation behaviors of different fibrous materials could
help to design and evaluate long term bandage performance.
 Material and construction parameters 103

Bandages could be applied with different force levels during wrapping

depending on the recommended pressure requirement. Varying applied force
in the bandage structure leads to varying stress developed in the structure due
to which a same fiber or yarn present in the structure may go to lower or higher
amount of stress relaxation depending on the developed initial stress in it.
Different yarns behave in complex viscoelastic fashion and try to relax more
under high stress conditions [18]. Varying number of yarns per unit area in the
bandage structure may also influence its relaxation behavior. Since, the total
resistance developed in the bandage upon application of external force gets
distributed to individual yarns and therefore under same applied force during
wrapping, a low stress state on each individual yarn in the structure could be
obtained if more number of yarns are present in the bandage structure. The
above facts indicate that the material type, the yarn or thread density and the
applied force could influence relaxation behavior of a bandage and hence,
could determine interface pressure variation over time.
To demonstrate the above concept, in the present chapter a series of
different compression bandages was examined over time using the leg-segment
prototype under static state of the mannequin limb. For this study, apart from
procuring commercial bandages, different knitted bandage samples with varying
thread density were also prepared with different yarns like cotton, viscose, PET,
elastomeric core spun etc., that are frequently used in making compression
bandages, to study the influence of the material type, the applied force and the
thread density on the interface pressure profile generated over time.

7.2 Materials and experimental methods

7.2.1 Bandages
Different commercial compression bandages were procured and examined for their
structural parameters and material characteristics. Table 7.1 provides the details of
different bandages used for experimental analysis. It has been observed that these
bandages are made of different spun or filament yarns consisting cotton, nylon,
elastane, PET etc. and have woven or knitted constructions. Elastomeric core-spun
yarns are found in the structure of some of these bandages (E, F and G). These
yarns provide higher extension along the length to these bandages. Elastomeric
core-spun yarn consists of Elastomeric yarns at the core which is wrapped with
staple fibres or filament yarns. Extension characteristic of a bandage is described
by its extensibility which is defined as the extension of the bandage under a load
of 10 N/cm [ENV 12718:2001]. Each of these bandages was classified to short-
stretch (Extensibility < 70%), medium-stretch (70% < Extensibility < 140%) and
long-stretch (Extensibility > 140%) based on their extensibilities measured.
104 Science of compression bandage

7.2.2 Preparation of experimental knitted bandage

samples
Different double jersey weft knitted bandages were prepared using V-bed
knitting machine. The machine gauge of the V-bed knitting machine was set at
12 needles per inch for preparing different samples. Knitted fabric consists of
consecutive rows of loops which are prepared using interlooping of yarns in
the structure [31]. Different types of yarns (e.g. cotton, viscose, PET, cotton-
elastane and PET-elastane) having nearly same linear density were used for
making different knitted bandages.

Table 7.1  Details of standard compression bandages.

Bandage
code A B C D E F G
Parameters

Weave Woven Woven Woven Woven Knitted Knitted Woven

Fibre-type Cotton Cotton Cotton Cotton Cotton Cotton Cotton

composition, (100%) (100%) (100%) (60.3%) (57.3%) (88.7%) (52.4%)
% Nylon Nylon Elastane Elastane
(39.7%) (35.5%) (11.3%) (47.6%)
Elastane
(7.2%)

Thickness, 1.26 0.92 0.86 0.5 1.15 1.3 0.75

mm

Mass per unit 525 270 349.6 181.4 290.2 319.5 161.5
area, g/m2

Linear density 53 56 56 40 111 104 38.2

of yarn, tex (warp) (warp) (warp) (warp) (course) (course) (weft)
72 35 (weft) 35 (weft) 25 103 108
(weft) (weft) (wale) (wale)

Threads per 18 19 19 18 15 17 17
unit length (warps/ (warps/ (warps/ (warps/ (courses/ (course/ (wefts/
cm) cm) cm) cm) cm) cm) cm)
27 16 28 31 9 (wales/ 7 (wales/
(wefts/ (wefts/ (wefts/ (wefts/ cm) cm)
cm) cm) cm) cm)

Extensibility 145 90 95 45 146 175 148

(%)

Long- Medium- Medium- Short- Long- Long- Long-

Classification
stretch stretch stretch stretch stretch stretch stretch
 Material and construction parameters 105

All of these yarns were having nearly same linear density of ~35 tex.
Selection of all the above yarns was purely based on yarn parameters that
are frequently used for making standard compression bandages. Elastomeric
core spun yarn (cotton-elastane or PET-elastane) consists of elastomeric yarn
at the middle which is wrapped with staple fibres or filament yarns. These
elastomeric yarns are also frequently used in making compression bandages
to impart elasticity in the structure. For each of the above yarn type, two
different bandages were prepared with varying thread densities (number
of yarns per unit length) in the structure. To increase thread density in the
bandage structure, number of yarns passing through the feeder of the V-bed
machine were increased. Table 7.2 gives the details of different weft knitted
bandages. For example, bandage sample A1 was made by feeding one cotton
yarn through the feeder of the V-bed machine while bandage A2 was prepared
by feeding two strands of same cotton yarn through the feeder in order to
increase the thread density in the structure. Because of feeding two yarns,
higher courses/cm was obtained for the prepared bandage sample. Because of
the increasing thread density the tightness of the bandage structure increased.
Looseness or tightness of knitted fabric structure is described by the tightness
factor (TF) which is defined as the ratio of the fabric area covered by the yarn
to the total fabric area [31].

7.2.3 Application technique

All the bandage samples were wrapped over the inflated air bladder under
constant force to achieve nearly same interface pressure. To obtain a particular
interface pressure by different samples, the technique given by Yildiz [32]
was followed.

Table 7.2  Details of laboratory manufactured knitted bandages.

Linear Thread density Mass Tightness

Fibre type Loop
Number density per Thick- factor
Sample composition length
Yarn type of yarn of yarn unit ness
code (l) (tex1/2/
feed (%) Wales Courses area (mm)
(tex) (cm) cm )
/cm /cm (g/m2)

A1 Spun One 36.2 Cotton (100%) 13 7 0.52 225.2 1.4 11.57

B1 Spun One 37.3 Viscose 13 9 0.53 211.9 1.7 11.52
(100%)
C1 Filament One 34.2 PET (100%) 13 8 0.52 213.9 1.6 11.25
D1 Elastomeric One 36.9 Cotton 15 14 0.45 403.1 1.9 13.50
core spun (92.6%)
Elastane
(7.4%)
E1 Elastomeric One 34.4 PET (91.5%) 16 13 0.44 359.1 2.1 13.33
core spun Elastane
(8.5%)
Cont...
106 Science of compression bandage

Cont...

Linear Thread density Mass Tightness

Fibre type Loop
Number density per Thick- factor
Sample composition length
Yarn type of yarn of yarn unit ness
code (l) (tex1/2/
feed (%) Wales Courses area (mm)
(tex) (cm) cm )
/cm /cm (g/m2)

A2 Spun Two 36.2 Cotton (100%) 13 20 0.53 547.1 2.0 16.05

B2 Spun Two 37.3 Viscose 13 19 0.54 483.6 2.1 15.99
(100%)
D2 Elastomeric Two 36.9 Cotton 13 24 0.48 628.1 2.3 17.90
core spun (92.6%)
Elastane
(7.4%)
E2 Elastomeric Two 34.4 PET (91.5%) 14 22 0.48 438.4 2.2 17.28
core spun Elastane
(8.5%)

The tensile load versus extension curve for each bandage was obtained
first and then different extension values were chosen for different bandages in
such a way that each of them was given nearly same applied force to obtain
equal pressure. Figure 7.1 shows the tensile behavior of two bandages (A
and B) to select different extension levels for bandages under same tension.
To wrap the bandage at a particular extension, a predetermined length of the
bandage sample was taken and then it was marked with uniform rectangular
shapes at regular spaces throughout the sample length and the procedure of
wrapping was ascertained after doing many initial trials to ensure uniform
square shape of each rectangle upon stretching.

Figure 7.1  Tensile characteristic of different bandages

 Material and construction parameters 107

7.2.4 Design of experiment

Three important parameters namely the material type, the applied force,
and the thread density were chosen to study their influence on the interface
pressure profile generated by different bandage samples over time. Interface
pressure profiles generated by each standard bandage samples as well as for
each prepared bandages were measured for 8 hours. For the analysis, the
decrease of the interface pressure was obtained after 0.25, 2 and 8 hours.
The pressure profiles of the individual bandages were obtained five times
using different samples of the same bandage material and the mean values
were calculated and used for subsequent analysis. All individual pressure
measurements were done on mannequin leg having circumference of 21.2
cm. The width of the each specimen was taken as 5 cm and two layers were
wrapped over the mannequin surface for each individual test. The method of
wrapping over the mannequin is already explained above; and this procedure
was ascertained after doing many trials prior to actual test.
For the analysis, the mean interface pressure drop (%) in 8 hours was
obtained for experimentally prepared knitted bandages at all possible levels of
chosen factors. An N-way analysis of variance (ANOVA) for a fixed effect model
was performed to determine whether there were any significant differences in
the mean pressure drop (%) in 8 hours at different levels of various factors. A
p-value less than 0.05 was considered as statistically significant.

7.2.5 Stress relaxation test

Stress relaxation test at a particular extension level was performed using an
INSTRON tensile tester (model-4301) and reduction of stress over 2 hours
relaxation period was obtained for each bandage separately. Each bandage
sample was extended at constant rate of loading (5 N/min) up to a peak tension
of 3 N or 5 N and then left for 2 hours of relaxation period. The gauge length
for each testing specimen was 10 cm and the width taken was 5 cm. The
decrease of the tension or stress was obtained after 15, 60 and 120 minutes
and used for analysis.

7.3 Results and discussion

7.3.1 Stress relaxation behavior of the bandages
All bandage samples exhibited stress relaxation under extended state. Table
7.3 shows the relaxation behavior of different bandage samples under different
tension levels.
108 Science of compression bandage

Table 7.3  Stress relaxation of prepared knitted bandages over time.

Initial Stress (kPa) in the material after Reduction

Sample Applied stress of stress
code force (N) 15 60 120 in 2 hours
(kPa) (%)
minutes minutes minutes

A1 3 42.8 (2.5) 33.8 (2.2) 29.4 (1.8) 28.8 (1.5) 32.7

B1 3 35.2 (2.3) 30.2 (2.2) 27.6 (2.6) 26.3 (1.8) 25.3

C1 3 37.5 (2.1) 32.6 (1.9) 30.5 (3.4) 29.6 (1.7) 21.1

D1 3 31.5 (2.2) 27.9 (1.8) 25.9 (3.5) 25.2 (1.5) 20.0

E1 3 28.5 (2.4) 27.3 (1.9) 26.3 (2.8) 25.6 (1.8) 10.2

A2 3 30.1 (2.4) 26.5 (1.6) 24.3 (2.5) 23.1 (1.4) 23.3

A2 5 50.0 (3.2) 36.8 (2.4) 34.2 (3.9) 32.2 (2.4) 35.6

B2 3 28.5 (1.9) 25.5 (2.1) 23.1 (2.8) 22.2 (1.8) 22.1

B2 5 47.6 (3.2) 34.3 (2.4) 31.6 (3.4) 28.9 (1.7) 39.3

D2 3 26.1 (2.4) 24.4 (2.0) 23.0 (2.9) 22.3 (1.5) 14.6

D2 5 43.4 (3.0) 35.3 (2.1) 33.4 (3.9) 33.6 (2.1) 22.6

E2 3 27.2 (1.9) 26.4 (2.2) 25.9 (2.9) 25.3 (2.1) 7.0

E2 5 45.4 (2.2) 42.6 (2.6) 40.9 (2.5) 39.1 (2.0) 13.9

Note: The values in the bracket represent SE (Standard Error)

It has been observed that under same applied force (3 N), sample made up
of 100% cotton yarn (A1) showed highest drop (32.7%) in stress while sample
made of elastomeric yarns (E1) showed lowest drop in stress (10.2%) in 2
hours. Higher percentage drop in stress was observed when the bandage was
extended with higher force (5 N) as compared to when it was extended with
lower force (3 N). For example, cotton bandage sample (A2) showed 23.3%
reduction of stress at lower force (3 N) while at higher force level (5 N) it
showed 35.6% reduction in stress. Similar results were also obtained for other
bandage samples made up of different fibers and higher drop of the stress has
been obtained at higher applied force.
 Material and construction parameters 109

7.3.2 Effect of bandage material

Different interface pressure profiles were obtained over time for different
bandages. Table 7.4 shows the variations of interface pressure over a period
of 8 hours for different standard compression bandages when applied under
same force (3 N).

Table 7.4  Variation of interface pressure over time for different bandages.

Initial interface Interface pressure (kPa) after, Mean

Bandage pressure pressure
code drop in
(kPa) 15 minutes 2 hours 8 hours 8hours (%)

A 3.42 (0.20) 2.75 (0.21) 2.32 (0.20) 1.85 (0.24) 44.8

B 3.31 (0.17) 2.96 (0.24) 2.64 (0.19) 2.20 (0.20) 33.5

C 3.41 (0.23) 2.77 (0.20) 2.33 (0.20) 1.89 (0.23) 44.1

D 3.37 (0.19) 2.56 (0.23) 2.37 (0.17) 2.19 (0.19) 34.9

E 3.42 (0.20) 3.36 (0.15) 3.31 (0.13) 3.28 (0.13) 3.9

F 3.39 (0.19) 2.87 (0.17) 2.77 (0.19) 2.72 (0.21) 19.0

G 3.34 (0.16) 2.97 (0.20) 2.88 (0.17) 2.69 (0.22) 19.2

Note: The values in the bracket represent SE (Standard Error)

It was observed that 100% cotton compression bandages (A, B and C) did
not sustain pressure for longer period. More than 30% reduction of interface
pressure was obtained for purely cotton compression bandages in 8 hours.
Decrease in the interface pressure was lower (less than 20%) for the bandages
(E, F and G) having elastomeric material in them. Similar results were obtained
for the prepared knitted bandages (Fig. 7.2). For the same applied force (3 N),
cotton bandage (A1) showed pressure drop from 3.4 kPa to 1.6 kPa (52.9%)
in 8 hours while bandage made up of elastomeric core spun yarn (E1) showed
pressure drop from 3.4 kPa to 2.7 kPa (20.6 %).
110 Science of compression bandage

Figure 7.2  Effect of material type on interface pressure profile generated over time for
different bandages
 Material and construction parameters 111

Relaxation behavior of a fabric structure depends significantly on

the relaxation behavior of fibers or yarns used in it. Relaxation time is
commonly used to describe stress relaxation behavior of a viscoelastic
material, which indicates the time required to reach from unrelaxed state
to new relaxed state of the material [19]. It has been found that cotton and
viscose fibers have the lower relaxation time due to which the relaxation
of stress is faster. Synthetic fibers (e.g. nylon, PET, elastane) have low
stress relaxation as compared to cotton fiber because of their higher
relaxation time. This could be the reason for different pressure profiles
obtained for different bandages. Higher and faster pressure drop for 100%
cotton and viscose samples were obtained because of their poor ability
to sustain internal stress in the structure. Table 7.5 provides the ANOVA
results which reveal that different fibers present in the bandage structure
significantly affects pressure drop (p < 0.05).

Table 7.5  ANOVA results to check the significant difference in the mean pressure drop (%)
for the prepared knitted bandages at various levels of the factors.

Sum of Degree of Mean

Source Fcalculated Ftable (p_value)
square freedom square

*Material 2251.78 3 750.59 67.73 3.71 0

*Applied force 274.56 1 274.56 24.78 4.96 0.0006

*Thread density 335.62 1 335.62 30.29 4.96 0.0003

Error 110.82 10 11.08

Total 2972.79 15

Note: The factors significant at 95% level of confidence are denoted by *.

Elastomeric yarns have excellent elastic and rheological properties.

They can maintain the internal stress for longer time because of their good
elastic properties [22]. It has been also observed that fabrics containing
elastomeric yarn tend to be tighter and have more number of threads per
unit area (Table 7.2). Similar results were obtained for the knitted bandages
(D1 and E1) prepared with elastomeric core spun yarns and relatively
higher number of course/cm and wale/cm was obtained as compared to
normal spun or filament yarns (A1, B1, C1). Lower pressure drop was
112 Science of compression bandage

obtained within 8 hr for these samples (D1 and E1) as compared to 100%
cotton or viscose samples (Fig. 7.2). This was because of lower stress
relaxation of elastomeric yarn that was present in their structure and also
due to their relatively tight structure; individual yarns were at lower stress
level.

7.3.3 Effect of thread density

Two different bandages were made for each yarn type with varying thread
densities as shown in (Table 7.2). Increasing the number of threads by
feeding more yarns simultaneously leads to increase in the tightness of the
structure. Figure 7.3 shows the interface pressure variation over 8 hours
at two levels of thread densities (low and high) for each material type. It
can be observed that for the same applied force (3 N) during wrapping, the
pressure reduction was lesser for a structure having higher courses/cm as
compared to the structure having lower courses/cm. For the same applied
force, pressure drop within 8 hours was from 3.4 kPa to 1.6 kPa (52.9%) for
the cotton sample (A1, 7 courses/cm) with loose structure, while pressure
drop from 3.4 kPa to 2.2 kPa (35.2%) was obtained for tight structure (A2,
20 courses/cm). ANOVA results shows that thread density significantly
affects pressure drop over time (Table 7.5).
The overall stress in the structure gets distributed to more number
of yarns due to increasing number of yarns per unit length. Therefore,
under same applied tension, the stress in the individual yarn structure is
less for the bandage having higher thread density as compared to lower
thread density. Due to lower internal stress in the individual yarn for
the structure having higher thread density, lower stress relaxation was
obtained. For example, cotton bandage (A1) having 7 courses/cm showed
32.7% reduction of stress while cotton bandage (A2) having 20 courses/
cm showed 23.3% drop in stress (Table 7.3). This could be the reason for
relatively lower reduction of interface pressure for the bandages having
higher thread density.
 Material and construction parameters 113

Figure 7.3  Effect of thread density on interface pressure profile generated over time for
different bandages
114 Science of compression bandage

7.3.4 Effect of applied force

Two levels (low and high) of the applied force (3 N and 5 N) were chosen
for the application of different bandages over the mannequin. Due to the
difference in the applied force during wrapping, different values of the initial
interface pressure were obtained. Figure 7.4 shows the effect of applied force
on the interface pressure variations over time for different materials. It has
been observed that the percentage reduction of the interface pressure was
higher at high force as compared to lower force for the same material type.
For viscose sample (B2), pressure drop within 8 hr was from 5.5 kPa to 3.1
kPa (43.6%) at higher level of applied force while it reduced from 3.3 kPa
to 2.3 kPa (30.3%) at lower level of applied force. Other bandage samples
made of different yarns were also showing similar results. It is observed
from (Table 7.5) that the applied force significantly affects the pressure drop
(p < 0.05).
Under stressed condition, fabric structure tries to reach a minimum
deformation energy state, like in any natural phenomenon, by stress
relaxation in the fibers or yarns and also by rearranging fibers or yarns in the
structure [21]. Increasing the applied extension or force in the fabric leads
to increase in the internal stress in the structure due to which it becomes
more unstable. This increases the rate and the amount of relaxation of
the fabric to attain a newly relaxed position having low internal stress.
It has been observed that the relaxation of stress in fiber, yarn or fabric
get pronounced at higher stress level. This may be the reason for higher
percentage drop of pressure for different bandages at higher force level
as compared to lower tension level. This was further substantiated by the
stress relaxation results of different bandages which showed larger drop
of the stress in the material under higher extension or tension level (Table
7.3).
 Material and construction parameters 115

Figure 7.4  Effect of applied force on interface pressure profile generated over time for
different bandages
116 Science of compression bandage

7.4 Conclusions
This present chapter aims to elucidate the influence of different material
types, thread density and applied force on the interface pressure profile
generated over time by the bandage. Interface pressure drop in the bandage
material is primarily due to relaxation of stress in the material under constant
extension. It has been found that compression bandages made up of 100%
cotton or viscose yarns show poor sustenance of pressure because of higher
relaxation of stress in the cotton or viscose fibers. Elastomeric core spun yarn
has good elastic property due to the presence of elastomeric yarn and hence
incorporating elastomeric yarn in the bandage structure showed improved
long term compression behavior of the bandage. Increasing the applied force
in the bandage material leads to more unstable state of the bandage structure
because of higher internal stress developed in it. This causes higher stress
relaxation and therefore larger percentage drop in pressure. Increasing thread
density in the bandage structure leads to lower reduction of pressure over time
because of redistribution of overall stress to more number of yarns. Hence
lower stress state on the individual yarn in the structure is obtained which in
turn lead to slow stress relaxation.

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