Hello fellow clinicians!
Many of you who read these articles will know how proper management of edema is a passionate and hotly debated topic over here at ARC Seminars HQ. Including edema control into your plan of care is vital for best practice with your patients. If you are not familiar with some of the different pathologies of edema that you may already have encountered clinically, check out our post on 7 types of swelling nurses and therapists should know about!
Once we get into the world of actually treating our patients and bringing their edema down, however, we enter tricky territory- including a whole host of new products and tools that are vital for treatment. Essential among these products is, of course, the short stretch bandage!
If you have attended a seminar, you will already know that short stretch bandages (SSBs) are the way to go when performed compression wrapping. ACE, or elasticated bandages, can’t hold a light to short stretch when it comes to swelling control, for many sound and well-researched reasons!
As I mentioned, ACE bandages are completely elasticated. This means that they stretch up to 300% of their original width! Short stretch bandages, on the other hand, stretch only to 50%. This creates an almost ‘soft cast’ around the limb, that a) does not restrict circulation, b) can be built up itself to create greater compression distally to proximally, c) does not move and stretch with the muscle of the limb as an elasticated bandage might. This results in much greater comfort for the patient, as their skin is supported from the weight and pressure of the edema.
In considering bandages, you must also think about Working Pressure and Resting Pressure. These are concepts used to describe the action of the bandages in resisting forces form the muscle underneath. When the bandage is WORKING it will not yield to the bulging muscle, or the refilling of the limb with lymph. RESTING refers to the compression when the limb is not in motion, the materials will not constrict around the limb as there is no elastic to shorten the materials at rest. ACE bandages, on the other hand, have a LOW working pressure, meaning that when the limb is at work, the bandage yields and does not support the bulging muscle, and when the limb rests, the elastic bandage constricts around the limb, cutting off circulation and leading to a host of other issues, including circulatory damage, soft tissue abrasions, and neuropathic impairment.
So we know we want to choose Short Stretch Bandages to treat the edema our patient is suffering from: But what bandage to choose?? There are several options out there, which I will discuss and compare so you can make the best decision for you and your patient.
Rosidal K, by Lohmann & Rauscher, is the classic short stretch bandage. Lohmann & Rauscher produce compression, wound care, and medical products and devices. Rosidal K, their shorts stretch bandage, is 100% woven cotton, and is washable and reusable up to 50 times before losing any of its compressive function or stretch.
This bandage I have found to have the nicest ‘hand feel’. It is less harsh on the skin, and doesn’t tend to cause too much discomfort to patients. Although the bandage ideally is never applied directly to skin, if I was using this bandage I would not worry if some skin contact occurred at the thigh or calf, where the wrap ended.
The quality of this bandage is clearly very high, and the packaging that it comes in is also nice: its own box with product information insert inside (handy for your patients who forget how many times they can wash and re-use it, or the washing instructions!).
The bandage is also latex free, which is important especially if working in a clinic with a latex protocol.
The pricing of this bandage tends to be the most expensive, at about $8.50 for a 10cm piece (the comparison size I’ll use today) at LymphedemaProducts.com, $4.61 at BandageGuru.com, $8.45 through BandagesPlus.com, and a mystifying $27.98 through Rolyan Prest on Amazon.com!
Sigvaris, Inc produces the Biaform bandage, as well as a large range of compression stockings and garments for all walks of life. Biaform is also a 100% cotton short stretch bandage, woven in order to give good stretch and conforming ability to the limb. I have found that this bandage, although it can be washed and dried like Rosidal, doesn’t hold up for as long under repeated washings. The bandage seems to lose its bounce-back quicker, and almost needs to be washed and dried after one wear to get best use- which is problematic as other bandages can be reused several times (unless soiled) before requiring laundering.
The quality and hand feel of this product feels less high, with a slightly rougher texture and a little harsher on the skin. The bandage comes packaged in a simple paper roll, with general instructions and indications printed on the inside- no washing instructions.
Biaform is also latex free, very useful for within the clinic.
Biaform is probably the most competitively priced short stretch bandage, making it a good option for people who are purchasing out of pocket. However, as it appears to be less durable, the attractive pricing may be a problem for people using it longer term. For a 10cm roll, you can find Biaform for $5.22 on BandageGuru.com, $6.90 on BandagesPlus.com, $8.50 on LymphedemaProducts.com, and $12.51 on Amazon.com.
Comprilan short stretch bandages are made by Jobst, a company specializing in edema and venous circulation products with a wide range of compression bandages, garments, and accessory devices. Like the others already discussed, Comprilan bandages are 100% cotton, woven, and latex free.
Comprilan bandages are also washable and reusable; however they do not need to be washed after every use, as the quality of the bandage means that after several wears it still has enough bounce back to work effectively. This brand of bandage also seems to hold up the best with very long term use, up to 7 months with repeated (twice weekly) washings before tearing or losing elasticity.
These bandages have a similar hand feel to Rosidal, if slightly less soft. The nature of woven bandages like all of the above mean that they are permeable to air, which works well for durability and skin sensitivity.
These bandages come packaged in a cardboard box with instructions, very useful for your patient managing their swelling at home.
Your choice of bandage will ultimately depend on your patient’s need. Biaform may be a good, cost-effective option if you feel that short stretch bandaging is only going to be used in the ‘acute’ stage of treatment, and your patient will be transitioning out of bandages relatively quickly. If your patient may be using these longer term, or using them multiple times over the years (with returning or fluctuating edema), a more durable option like Rosidal K or Comprilan may suit you better. However, if you are buying materials for your clinic, and want to use the highest quality for patients with frail skin and wound issues, I would select Rosidal as the top brand.
Bear in mind, that if ordering online, many companies can give a good sized discount to your patient, which can bring pricing down. LymphedemaProducts.com offers a 10% discount to new members; BandagesPlus gives free shipping on orders over $75. Bandage Guru offers free shipping, a lowest cost guarantee, and also has great returns policy (within 30 days for most products). It is worth always considering contacting bigger companies if ordering in bulk to ask for a discount or prove match also, to make sure you are getting the best band for your buck!
I hope you found this article helpful and informative! Let me know your experiences with these different products, and join the conversation!