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Introduction Controversy exists over the best dressing for conservative management of exomphalos major. Here we describe our experience of using Manuka Honey. Methods Our regimen involved covering the sac with Manuka honey (Advancis Medical™) wrapped with gauze and crepe bandage. Initially, dressings were changed 3 times a week and then twice weekly until full epithelialisation. Babies went home after reaching full feeds, with our outreach nurses continuing dressings in clinic until the parents were trained to do them alone. Only patients needing management of co-morbidities were transferred to our unit. Patients would be reviewed by video consultation. Data was prospectively collected. Results From 2011–2019, 24 consecutive patients (11:13 M:F; median gestation 37 weeks, birth weight 3.1 kg) with exomphalos major were managed with honey dressings. Fourteen babies had significant associated anomalies of which 10 died of problems unrelated to the exomphalos. Time to full feeds 6 (2-58) days; time to discharge 21(7–66) days if no associated anomalies; time to epithelialisation 73 (27–199) days. Dressings were well tolerated. Definitive closure occurred at 17(11–38) months and was uneventful. No patient required fundoplication and all patients were orally fed. Only one patient developed a clinically significant infection. Conclusion This is the largest report of using Manuka honey for the management of exomphalos major. Benefits include early feeding, early discharge and a ‘normalisation’ of the neonatal period. Key to our success was the surgical outreach service supporting parents doing the dressings, first at the local hospital and then at home.

Objetivos: Apontar os gastos com insumos utilizados no tratamento de feridas crônicas e comparar os custos entre o tratamento convencional e fitoterápico de lesões crônicas em um ambulatório. Métodos: Estudo de natureza documental e descritiva com abordagem quantitativa, desenvolvido em um ambulatório, designado para o tratamento de feridas crônicas. Desenvolveu - se por meio da análise dos prontuários dos pacientes atendidos no ambulatório, entre os meses de agosto a outubro de 2018. Para análise dos dados foi utilizado a estatística descritiva. Os resultados obtidos foram compilados e subsidiaram a análise comparativa a partir de duas categorias: a primeira se referiu aos insumos e a segunda abordou as coberturas utilizadas para o tratamento, sendo subdivididas em tratamento convencional e tratamento fitoterápico. Resultados: Dentre 344 atendimentos, constatou-se que os gastos com insumos que tiveram maiores custos foram: luvas estéreis (R$711,17), solução fisiológica a 0,9% (R$ 357,86), atadura de crepe com 20 cm (R$ 312,44), luvas de procedimento (R$ 247,08) e gazes (R$178,60). Quanto às coberturas, foi verificado ao final dos atendimentos um custo total de R$ 627,87 para coberturas convencionais e R$ 103,20 para coberturas fitoterápicas. Conclusão: A realização da pesquisa permitiu comparar custos e comprovar que a utilização de coberturas fitoterápicas possui um menor custo quando comparada a coberturas convencionais. Palavras-chave: Ferimentos e Lesões; Fitoterapia; Plantas Medicinais; Custos e análise de custo.

Introduction: Lower-extremity ulcers represent the largest group of ulcers presenting to an outpatient department. It is a cumbersome, difficult to treat disease, which causes high morbidity and huge cost for the patient and healthcare system. Current standard treatment includes compression therapy. However, majority of patients need long term treatment with minimal efficacy. Aim of our study is to evaluate efficacy of four layers compressive bandages for the management of chronic venous ulcers. Methods: In Group A, we have prospectively included 20 patients with chronic venous ulcers on lower limbs for four layers hosiery bandage using Velfour bandage. Other 15 patients, Group B, were treated with conventional wound dressing. Velfour and crepe bandage were done once weekly for three weeks. Results: DVT was cause of chronic venous ulcer in 70% patient in group A and in 73.3% in Group B. Majority of patients were having left sided chronic venous ulcers. The mean duration of the ulcers was 15.6 vs 10.86 months (group A vs. group B). At the end of 3rd week, in 55% wounds in Group A were healed except few big and deep wounds remained. Most of these wounds also became smaller with minimal discharge. Size of wounds significantly decreased in Group A vs. Group B patients (0.7±0.81 cm vs. 1.73±0.77 cm, p

Background: Spinal blockade provides excellent anesthesia for patients undergoing cesarean section. However, hypotension after spinal anesthesia is a common adverse effect that is commonly experienced in patients undergoing cesarean section. The aim of our study was to analyze if a simple technique like leg wrapping with elastic crepe bandage would be effective in controlling postspinal hypotension. Materials and Methods: Sixty full-term pregnant patients who were posted for cesarean section belonging to American Society of Anesthesiologists I and II were divided into two groups. Patients in Group W had their legs wrapped with elastic crepe bandage and in the other Group N, leg wrapping was not done. All the patients were preloaded with Ringer lactate at 10 ml/kg before the spinal anesthesia. The hemodynamic parameters were monitored every 3 min until the delivery of the baby and every 5 min until the end of surgery. If hypotension occurred, then along with crystalloid loading a bolus dose of mephentermine 6 mg was given intravenously. Statistical Analysis: Statistical software “Numbers version 3.6.1 (2566)” was used for statistical calculations. Results: Frequency of hypotension in Group W (10%) was significantly less compared to Group N (60%). Vasopressor requirement was significantly less in Group W (P = 0.009), which was highly significant. Conclusion: Wrapping of lower extremities was a simple, easy, and an effective method of decreasing episodes of hypotension and vasopressor requirement after spinal anesthesia in cesarean patients and needs to be practiced routinely.

The purpose of this research was to assess registered nurse understanding of bandaging principles and the extent of crèpe bandage use. Measurements were made by the use of a self-administered questionnaire designed for the purpose. Results indicated that the principles of bandaging are not well understood and that there is a high reliance placed on the use of crepe bandages. This suggests that the appropriate use of bandages, particularly for compression purposes, is below an acceptable level, which has implications both for nurse education and the availability of products

This study was conducted in a district general hospital to compare the effect of three types of bandages applied following standard varicose vein operations. The three bandages studied were Crepe® bandage, Tensopress®, and Panelast®. The study included 60 patients and took place over a period of a year. All patients coming for a varicose veins operation were included in the study, including those with recurrent varicose veins. Patients were assessed before and after the operation and changes were recorded. The study showed that 91% of patients benefited from the operation, and their symptoms improved significantly. However, there was no significant difference among the different bandage groups with respect to the overall improvement in symptoms (p= 0.004) and cosmetic appearance (p = 0.005). Tensopress showed significant control of bleeding than did the other two bandages (p > 0.05), and Crepe bandage showed improvement in leg swelling (p > 0.05) and was more comfortable than the other two bandages (p = 0.1). There were no mortalities, and 91% of patients were treated satisfactorily as day surgery.

The plasma of monkeys envenomated with tiger snake (Notechis scutatus) venom was monitored by radioimmunoassay for both crude venom and a neurotoxin. When the injected limb was immobilised and a pressure of 55 mm Hg applied to the injection site, only very low levels of circulating venom or neurotoxin were detectable. In practical terms, venom movement can be effectively delayed for long periods by the application of a firm crepe bandage to the length of the bitten limb combined with immobilisation by a splint. Pressure alone or immobilisation alone did not delay venom movement.

Much variability exists in the postoperative mobilization management after modified Wilson’s osteotomy for hallux valgus. This study aimed to elicit the differences, if any, between weightbearing following surgery as managed with a plaster slipper as compared to that of a crepe bandage. Fifty-four operated feet were randomly entered into a prospective trial. All feet underwent identical operations. When a crepe bandage was used there was no significant difference in the rate of complications, or in the patient’s assessment of postoperative pain relief. Patients treated with a crepe bandage were back to full activity as quickly as their plaster slipper counterparts and the patient’s overall assessment of the operation was no different.

Summary Much variability exists in the postoperative mobilization management after first metatarsal phalangeal (1st MTP) joint fusion. This study aimed to determine the differences, if any, between weight bearing following surgery as managed with a plaster slipper as compared with that of a crepe bandage. Fifty-two operated feet were randomly entered into a prospective trial. All feet underwent identical operations. When a crepe bandage was used there was no significant difference in the rate of complications, or in the patient's assessment of postoperative pain relief. Patients treated with a crepe bandage were back to full activity significantly more quickly than their plaster slipper counterparts and the patient's overall assessment of the operation was better. In addition transfer to crepe bandage mobilization would be more cost-effective and reduce the demand on the time of trained personnel for application of a plaster. It is therefore proposed that patients are mobilized after first metatarsalphalangeal joint fusion, weight bearing in a crepe bandage.

We evaluated the use of Suprathel(®), a synthetic skin substitute, for partial thickness burns in children. Thirty-three children (20 females, 13 males; mean age 29 months, range 5 months to 11 years) with burns were treated with Suprathel(®). The burns were superficial partial thickness (n=24) or mid-dermal (n=19); the median %TBSA was 4% (range 1-13%). Suprathel(®) was applied after debridement, followed by Vaseline gauze, dry gauze and crepe bandage. The outer dressings were changed every 5-10 days unless clinical problems dictated otherwise. Median healing time was 16 days (range 9-38 days). Ten patients took longer than 21 days to heal, of whom four developed hypertrophic scarring, which was strongly associated with wound infection (p

Hand surgery is facilitated by the production of a bloodless operative field by exsanguination and the use of a pneumatic tourniquet. Exsanguination can be achieved by a variety of techniques, including elevation alone, use of an Esmarch or crepe bandage, or a Rhys-Davies exsanguinator. 1–3 We present a simple, effective method of exsanguination of the hand for use in procedures performed under local anaesthesia such as carpal tunnel decompression. No additional equipment is required and therefore there is no risk of transmission of infection. The hand is exsanguinated after surgical preparation and draping, thus minimising the tourniquet time.

Twenty-nine patients with ganglion of the wrist were treated in this hospital using hypertonic saline as sclerosant. All patients were treated as outpatients. Under aseptic conditions, the ganglia were aspirated using #18 hyperdermic needle. A mixture of 2cc of hypertonic saline and 1cc 1% xylocaine were injected into the empty cavity and crepe bandage applied for 24 – 48 hours. After a follow-up period of 24-36 months, there was only one recurrence which was believed to be accidental injection of the saline outside the empty cavity. This was treated by the same procedure. The most common complication was swelling of the wrist and dorsum of the hand which were seen in 50% of cases. This subsided spontaneously within 72hrs of treatment. Severe pain necessitating ingestion of analgesics (Paracetamol) was reported in 6 patients (20%), which subsided within 48 hours. It is hoped that this new treatment which is cheap and less invasive may be a break through in the treatment of ganglia which hitherto was characterised by high recurrence rate of up to 23%. Keywords: Ganglion, Treatment, Hypertonic saline, Sclerosant. Resume Vingt-neuf malade avec ganglion du poignet etait traite dans cette hospital utilisant hypertonique salin comme sclerosante, Toutes les malades etait traitee comme consultation extenes. Sous conditions aseptique chaque ganglion etait aspire employant 18 seringue hypodermique. Une melange de 2cc de hypertonique salin et 1cc 1% Xylocasine etait injects dans la cavite vide et un bande relpeau mis pendant 24-48 heures. Apres une period de 24 – 36 mois de poursuite, il y'avez qu'un cas de reappanition peut-etre a cause de injection accidental de salin a exterieur de cavite vide. C'etait traiter suivant la meme methode. Le complication le plus frequent etait le gonflement du pour porgnet en 50% des cas. Sace de ganfler spontanement pendant 72 heure de traitement. Dandeur vcocentre necessitant le ingestion de analgesique (paracetamol) etait reporter en 6 malade (20%), qui se baisser pendant 48 heures. Ont espere que cet nouvaux traitement qui nest pas cher est moin invasive peut-etre un bond en avant dans le traitement de ganglion qui etait characterise par un haut reapparition' de presque 23%. West African Journal of Medicine Vol.22(1) 2003:13-14

Elevation of limbs during burns surgery to access the posterior aspect is routinely required. We describe a method of limb holding during burns surgery using sharp towel clips fixed to the distal phalanges of a patient's hands or feet. The limb is held in elevation using a sterile crepe bandage from the towel clips to a hook hung on a rail fixed to the theatre ceiling. We have used this technique for patients with extensive severe burns for many years with no significant damage to the nail beds or the tips of fingers and toes. This technique is convenient for surgeons as it allows easy access to hands and feet and the posterior aspects of arms and thighs. It is cost effective and safe as it spares an assistant and decreases the risk of potential occupational injury. Level of Evidence: Level V, therapeutic study.

The first official British standards for bandages appeared in a supplement to the 1911 British Pharmaceutical Codex (BPC) which included a specification for crepe bandage, as well as monographs for simple non-extensible products such as calico, flannel, domette and open-wove bandages. These bandages had a simple retention function although they also provided warmth and protection.

Objective: The ankle sprain is the most common type of sports injury. Conventionally acute ankle sprains are treated with controlled mobilization by using external support such as crepe bandage and taping. Fiberglass cast is a new material that provides better control mobilization. Hence, the purpose of this study is to compare between effectiveness of fiberglass cast over the crepe bandage and taping. Materials and Methods: Thirty two participants (both male and female) with grade I and II lateral ankle sprain, with mean age of 20.94 years were included in the study based on inclusion and exclusion criteria, and were randomly assigned into two groups (group-A and group-B; (n=16). Participants in group-A received fiberglass casting whereas participants in group-B received crepe bandage with taping for 7 days each. Pain, range of motion (ROM), and foot ankle disability index (FADI) were measured in both pre and post intervention. Results: The findings of this study showed that pain, ROM, and FADI considerably improved in both the groups; however, there was a significant improvement in the group that was treated with fiberglass cast. Conclusion: Two layers of fiberglass cast showed better result than crepe bandage with taping. In conclusion fiberglass cast can be integrated as a secure method of treatment in addition to conservative management of acute lateral ankle sprain.

After iontophoresis, it was noticed that a child had a circular 'punched out' mark of about 2 mm diameter penetrating the skin to full thickness. A stitch was inserted to close up the wound and minimal scarring was visible at follow-up. The likely cause of the mark was explained to the parents who consulted a solicitor. The hospital received two letters enquiring about the accident, but there was no subsequent action and no compensation was requested. The child had eczema but not where the electrodes were placed (instructions state that iontophoresis must not be performed at the site of any skin lesion). Investigation showed that the most likely cause of this bum was contact between the metal electrode and the skin, probably due to it slipping from the calico sleeve when the child struggled. The remedy was to replace the electrodes with button type enclosed in sleeves with a 'button hole' opening away from the skin and to loop the wire from the electrodes under a crepe bandage to give some slack.

A study was carried out to compare the effectiveness of upper limb exsanguination using the Esmarch bandage, a crepe bandage and the Rhys-Davies exsanguinator. Upper limb volume changes were measured in ten volunteers using a water displacement method. The crepe bandage produced a mean volume reduction of 59 ml (range, 39–94), which was very similar to the Esmarch bandage, which achieved 63 ml (range, 42–101). This difference is negligible in practical terms. Both bandages were more effective than the Rhys-Davies exsanguinator, which reduced the volume by a mean of 28 ml (range, 11–54). It is our opinion that the use of the Esmarch bandage in hand surgery is unnecessary and recommend the crepe bandage as a safer alternative.

The author discusses ’functional therapeutic phlebological methods’ and illustrates this approach to treatment in four different situations.

The authors evaluated three methods of sterilizing Esmarch bandages. A commercially available autoclave tape laid along the whole length of the midpoint of the width of the bandage was used to determine sterility. Satisfactory sterility was achieved by rolling the Esmarch loosely, with a standard crepe bandage interposed between layers. Tightly rolled bandages and folded bandages without the crepe bandage interposition could not be reliably sterilized.

In a prospective study from January 1985 to December 1987, 60 consecutive patients with isolated fractures of the shaft of the ulna were divided into two groups. In group I, 28 patients were treated with plaster-of-Paris cast splintage, while in group II, 32 patients were given an elastic crepe bandage support and were mobilized early. Average time to union in group I was 10.8 weeks while in group II it was 7.8 weeks. Two fractures in group I did not unite, whereas there was no case of non-union in group II. Isolated fractures of the ulna can be treated successfully with minimal support and early mobilization.

Meyer FJ, McGuinness CL, Lagattolla NR, et al . Randomized clinical trial of three-layer paste and four-layer bandages for venous leg ulcers. Br J Surg 2003;90:934–40. [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] Q Are 3 layer paste bandages as effective as 4 layer bandages for healing of venous leg ulcers? ### ![Graphic][5] Design: randomised controlled trial. ### ![Graphic][6] Allocation: {concealed}*. ### ![Graphic][7] Blinding: unblinded. ### ![Graphic][8] Follow up period: 1 year. ### ![Graphic][9] Setting: a hospital leg ulcer outpatient clinic in London, UK. ### ![Graphic][10] Patients: 133 patients (56% men) with venous leg ulcers. Exclusion criteria: arterial disease, diabetes mellitus, rheumatoid arthritis or systemic lupus erythematosus, positive sickle cell test, HIV infection, ulcer area 100 cm2, known sensitivity to paste, or ulcer not of venous aetiology. ### ![Graphic][11] Interventions: 3 layer paste bandages (a Steripaste® hypoallergenic paste bandage, a Setopress® compression bandage, and a Tubigrip® bandage to hold everything in place) (n = 64) or 4 layer bandages (Velband® orthopaedic wool, a crepe bandage, an Elset® compression bandage, and a Coban® bandage to secure preceding layers) (n = 69). Fully trained ulcer clinic nurses applied the bandages. Patients were initially seen weekly in … [1]: {openurl}?query=rft.jtitle%253DThe%2BBritish%2Bjournal%2Bof%2Bsurgery%26rft.stitle%253DBr%2BJ%2BSurg%26rft.aulast%253DMeyer%26rft.auinit1%253DF.%2BJ.%26rft.volume%253D90%26rft.issue%253D8%26rft.spage%253D934%26rft.epage%253D940%26rft.atitle%253DRandomized%2Bclinical%2Btrial%2Bof%2Bthree-layer%2Bpaste%2Band%2Bfour-layer%2Bbandages%2Bfor%2Bvenous%2Bleg%2Bulcers.%26rft_id%253Dinfo%253Adoi%252F10.1002%252Fbjs.4173%26rft_id%253Dinfo%253Apmid%252F12905544%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1002/bjs.4173&link_type=DOI [3]: /lookup/external-ref?access_num=12905544&link_type=MED&atom=%2Febnurs%2F7%2F1%2F21.atom [4]: /lookup/external-ref?access_num=000184864800006&link_type=ISI [5]: /embed/inline-graphic-1.gif [6]: /embed/inline-graphic-2.gif [7]: /embed/inline-graphic-3.gif [8]: /embed/inline-graphic-4.gif [9]: /embed/inline-graphic-5.gif [10]: /embed/inline-graphic-6.gif [11]: /embed/inline-graphic-7.gif

A prospective randomized single blind trial was performed of 102 patients undergoing carpal tunnel release. Patients received either a palmar plaster of Paris splint or a bulky wool and crepe bandage postoperatively for the first 48 h, to determine whether the plaster slab reduced postoperative pain. There were no statistically significant differences between the two groups in postoperative pain scores or analgesic use.

Unilateral Colles' fractures in 187 patients over the age of 55 years were studied in a randomised prospective trial: 97 fractures were minimally displaced and were treated either conventionally or in a crepe bandage; 90 displaced Colles' fractures were reduced and of these 47 were treated conventionally while 43 were encouraged to mobilise the wrist in a cast which restricted extension. Early wrist movement hastened functional recovery and led to earlier resolution of wrist swelling. Discomfort was no greater than in patients who were treated conventionally. The bony deformity, which recurred irrespective of the method of treatment, was not adversely affected by early mobilisation.

Summary 1.The methods at present in use for control of palmar h˦matoma are discussed and criteria for a satisfactory level of pressure under a dressing suggested. 2.A recording system for pressure measurement beneath dressings is described. 3.Pressures are reported beneath several types of dressings initially and over a period of 48 hours. 4.The ability of these dressings to resist h˦matoma formation is investigated. 5.The characteristics of individual components of dressings are tested. 6.It is concluded that polyurethane foam in combination with crepe bandage has several advantages over other materials and methods tested. Great care must be exercised if plaster of Paris is used over foam and crepe. 7.The application of polyurethane foam pressure to grafting procedures and possible extension to flap surgery is noted.

An inner tube was inflated and then surrounded with plaster wool and plaster-of-Paris bandages. The plaster and the wool were next progressively divided. There was no significant reduction of the pressure inside the tube until both the plaster and the wool had been divided and separated from the inner tube along the entire circumference. These findings demonstrated that wool and plaster applied to limbs likely to swell should be split right down to skin and widely separated immediately after their application. A plaster slab is safer still, but the wool must be cut before the crepe bandage is applied.

The significance of reports1,2, that topical application of house dust mite (HDM) to abraded or excoriated uninvolved skin of patients with atopic eczema can provoke an eczema-like reaction is controversial. We have therefore studied 17 adult in-patients with atopic eczema who demonstrated positive prick tests to Bencard HDM solution. One ml of Bencard HDM solution was applied, under a crepe bandage, daily for 5 days to an untreated 10 cm2 mildly eczematous area behind one knee, and diluent only, similarly, to the other knee in a double-blind fashion. Test sites were assessed daily for itch using a visual analogue scale and for severity of erythema, papules and excoriation using a 3-point grading system. Comparing these parameters between active and control sites for each patient, local worsening of eczema in response to HDM was marked in 5/17, moderate in 3/17 and mild in 4/17 subjects, while mild deterioration with diluent only occurred in 3/17. Mean area of active eczema increased by 6 26 ± 8 4 cm2 (± SD) at HDM-treated and by 0 5 ±1.5 cm2 at control sites (P≤0.01; paired t-test). Further patients exposed to Bencard horse hair extract, to which they were prick-test negative, in place of HDM, showed no reaction. These results indicate that HDM can exacerbate pre-existing atopic eczema.