Bandaging Protocols

Clinical Objective

Apply and manage bandages for postoperative wounds in a manner that protects the site, supports healing, prevents self-trauma, and allows regular assessment. Incorrectly applied bandages are themselves a cause of wound complications.

Protocol Steps

1. 1

   Assess the wound and surgical site to determine whether bandaging is indicated and what type is appropriate.

2. 2

   Prepare the skin: ensure the perilesional skin is clean and dry before application.

3. 3

   Apply primary contact layer (non-adherent, moisture-wicking) directly against the wound.

4. 4

   Apply secondary padded layer (cast padding, cotton roll) to provide cushioning and absorb exudate.

5. 5

   Apply tertiary conforming and cohesive layer with uniform pressure — avoid circumferential tightness.

6. 6

   Check bandage pressure: the '2-finger rule' — two fingers should slide under the proximal bandage edge.

7. 7

   Schedule bandage changes at appropriate intervals (typically 24–48h initially, then every 2–3 days for clean wounds).

Key Pitfalls to Avoid

• Applying bandages too tightly, causing pressure necrosis, particularly over bony prominences.

• Failing to pad bony prominences (lateral malleolus, olecranon, calcaneus) before conforming wrap.

• Infrequent bandage changes, which allow maceration of the wound and undetected infection.

• Wetting of the bandage — once wet, a bandage must be changed immediately regardless of schedule.