DESMURGY

From Big Medical Encyclopedia

DESMURGY (Greek desmos communication, a bandage + put ergon) — the doctrine about bandages, their correct use and imposing at various damages and diseases. The purpose of imposing of bandages — to hold a dressing material on the body surfaces (strengthening bandages) if it is necessary with pressure upon the subject fabrics (compressing bandages); to immobilize some part of a body (motionless bandages) or to create a possibility of draft for the extremity, the head etc. (extending bandages). A special type of bandages — bandages with filmogens.

The strengthening bandages and bandages with filmogens apply in surgery and specialties, boundary with it, and motionless and extending — hl. obr. in traumatology and orthopedics (see. Extension , Immobilization ). The term «bandage» designate also this or that preparation from dressing material (see) with medicinal substances or without them, imposed on a wound or on some body part with to lay down. or the preventive purpose (see. Bandages ). Process of imposing of a bandage is called bandaging (see. Bandagings ).

HISTORY

the First data on use of bandages belong to an extreme antiquity. At the time of Hippocrates (5 — 4 centuries BC) for deduction of a dressing material used an adhesive plaster, pitches, a canvas. One of classical bintovy head bandages is connected with a name of Hippocrates. There are data on use of the special devices and extension bandages applied at treatment of changes and correction of various rachiocampsis and extremities in those days.

A. Tsels (1 century AD) mentions bintovy bandages. K. Galen (2 century AD) applied a mitella at a fracture of a clavicle. In works of the Arab scientific 9 — 11 centuries it is mentioned plastering at changes (the injured extremity was filled in with plaster gruel).

In the Middle Ages applied bandages with extension [Guy de Chauliac]. In 14 century the method of an extension per continuitatem is described by a load at dislocations and fractures. In 16 century fr. surgeons used various devices and prostheses to this purpose. In 17 century J. Schultes a bandage on an extremity was offered [by name it is mute. the doctor J. Schultes], consisting of the bound strips of fabric. In 18 century the adhesive bandage entered the use.

Before use of antiseptics in surgery the wound was covered with the lint (split on separate threads by linen and cotton rags), edges kept on a wound by means of bandage, preferential made of cloth. Emergence of gauze bandage simplified imposing of bandages.

To the middle of 19 century almost all existing bintovy bandages were created, and since then this section D. developed a little.

Further use of glue bandages (a collodion, kleol, bandages with filmogens) and mesh bandages (hosiery) created an opportunity to considerably save a dressing material. More and more broad development was gained by the doctrine about motionless bandages and bandages with extension as about methods of treatment of changes. From slowly drying starched and glue bandages surgeons passed to quickly hardening plaster bandages, the improvised tires began to replace standard and devices for extension.

Big merits in development of questions D. belong to domestic surgeons: To N. I. Pirogov, G. I. Turner, A. A. Bobrov, R. R. Vreden, H. To M. Kefer, M. I. Sitenko, H. To M. Volkovich, H. To N. Priorov, V. V. Gorinevskaya. N. I. Pirogov entered a plaster bandage into practice, to-ruyu it for the first time applied in field conditions. This bandage forced out the starched bandage offered by L. Seutin in 1840

the STRENGTHENING BANDAGES

Bezbintovy bandages

the Adhesive bandage

Fig. 1. An adhesive bandage for rapprochement of edges of a wound.
Fig. 2. Adhesive bandages of different types.

The dressing material on a small wound can be withheld by strips of an adhesive plaster which, covering it it is dense, are pasted to surrounding healthy skin. Applying such bandage, paste several strips of an adhesive plaster in parallel each other (fig. 1), crosswisely or find a circle from a plaster, having made an incision it at the edges and having given it a type of a star (fig. 2). It is impossible to stick even small wounds and scratches with an adhesive plaster without gauze laying since under a plaster the dry scab is not formed, the wound becomes wet and usually suppurates. At small superficial wounds it is possible to apply with success an ofitsinalny bactericidal adhesive plaster — an adhesive plaster with a narrow strip of the bactericidal gauze imposed in the middle of a sticky surface of an emplastic tape. The strengthening adhesive bandages have a number of shortcomings: irritation of skin under a plaster, especially at frequent bandagings, impossibility of their use on pilar parts of a body, lag of a plaster from skin during the blotting of a bandage wound separated.

Glue bandages

During the imposing of such bandage use kleol (see), rubber adhesive and other kleyushchy means.

Fig. 3. The Kleolovy bandage (the dotted line designated the napkin imposed on a wound)

Kleolovy bandage. Having covered a wound with the gauze put in several layers, skin in a circle of a wound is greased kleoly and waited until it a little dries up. After that the surface greased kleoly is covered with the stretched gauze napkin (fig. 3) and densely it is pressed. The edges of a bandage which did not stick to skin cut off scissors. The Kleolovy bandage does not pull together and usually does not irritate I mow; therefore it can be applied repeatedly. Kleolovy bandages are convenient during the transportation of the patient since gluing of its edges to skin interferes with the shift of a dressing material.

Rubber adhesive apply as well as kleol. It is especially convenient for bandages at children since such bandage does not blot at hit on it of liquid, e.g. urine.

Collodion bandage it is applied at small damages, and also during the closing of the sewn-up operational wounds which are not demanding frequent bandagings. Technology of imposing of collodion bandages is similar to imposing of kleolovy bandages. On 7 — the 8th day the bandage usually easily lags behind skin. Lack of a bandage: tightening and irritation of skin at numerous use on the same place. The collodion is flammable (easily ignites).

Fig. 4. T-shaped bandage: at the left — a habit view; on the right — the T-shaped bandage is applied a crotch.

The T-shaped bandage

Consists of a strip of matter (gauze), the cut is sewn to the middle (or will throw through it) the end of other strip. It is the most convenient to apply this bandage on a crotch: tie with a horizontal part of a bandage a waist in the form of a belt, vertical strips go from a belt through a crotch and are attached to it on the other side of a trunk (fig. 4).

Mitella

Fig. 5. Mitella: bandages on a nose and a chin
Fig. 6. A mitella on a nape and a cinciput.

The mitella is made of strips of matter or a piece of bandage, both ends to-rogo are made an incision in lengthwise direction (cuts do not reach the middle). This bandage is recommended to be put on a face, especially for Nov. An uncut part of bandage is put across the person, closing Nov; the ends cross in the field of zygomas, and the lower ends go above ears, and upper — below; top ends are tied behind — on a nape, lower — on a neck. Imposing of a similar bandage on a chin, on a nape and on a cinciput is shown in figures 5 and 6.

A triangular bandage

the Kerchief — the triangular piece of some matter or a scarf put by a corner (fig. 7). Its longest party is called the basis (B V), the corner lying against it — a top (A), other two corners — the ends (B, In). Apply a kerchief at first-aid treatment, and in hospital conditions — to suspension of a hand. The middle of a kerchief is put under the forearm bent in an elbow at right angle and the basis (BV) have on the centerline of a body, the top (A) is directed to an elbow between a trunk and a hand, the ends are tied on a neck. The top is straightened and attached a pin to the forefront of a bandage. Triangular bandages can be applied also other parts of a body (fig. 7 — 11).

Bintovy bandages

Bintovy bandages are strongest and convenient. To bandaging of a brush and fingers apply bandage 5 cm wide, to the head, a forearm, a shoulder — 7 — 9 cm, to a hip and a trunk — 8 — 20 cm.

Main types of bintovy bandages: circular — the courses (tours) of bandage completely close each other; spiral — each tour of bandage only partially covers previous; cross-shaped, eight-figurative and kolosovidny — tours of bandage cross each other across or obliquely. On cone-shaped parts of a body (extremities), especially on a forearm and a shin, tours of a spiral bandage lay down unevenly, one edge of bandage crashes, on another there is a weak point. In order that it was not, bandage is overturned; having held a spiral round, the head of bandage is overturned so that its face becomes a wrong side; the next tour comes to an end with capsizing of bandage in the opposite direction etc. Places of excesses of bandage shall be located in a straight line.

During the bandaging of the patient shall hold a comfortable position. The bandaged part shall be at the level of a breast of bandaging, to be available to it, motionless and to be located in that situation, in Krom it remains upon termination of bandaging. Fingers bandage extended, a brush — straightened, an elbow — bent at right angle, a shoulder joint — at the hand which is a little taken away from a trunk, coxofemoral and knee joints — at the extended leg, to stop — in situation at right angle to a shin. Bandaging shall see a face of the patient and watch whether he causes bandaging of pain; upon termination of bandaging it is necessary to check whether the bandage is not hardly applied.

Head bandage and neck

The returned bandage of the head can cover all calvaria. It has an appearance of a hat (fig. 12). Better the kind of this bandage — a cap («miter») of Hippocrates keeps, edges it is imposed by means of two-headed bandage or two separate bandage. Do to one of bandage throughout all bandaging circular turns through a forehead and a nape, strengthening the courses of the second bandage covering a calvaria.

Fig. 12. The returned bandage of the head.

Cap — the head bandage strengthened by a strip of bandage to a mandible (fig. 13). A piece of bandage (tie) a little less than 1 m long put it on area of a darkness, the ends (and and b) lower vertically ahead of ears. Around the head other bandage make the first move (2), then, having reached a tie on the right side of the patient, bandage is wrapped around it (2) and conduct a little slantwise, covering parietal area. After the circular course around the left half of a tie bandage is conducted slantwise, covering a nape (3). On other party bandage is thrown around the right half of a tie and conducted slantwise, covering a forehead and a part of a darkness. So, throwing every time bandage through a tie, it is conducted more and more vertically, yet will not cover all head. After that bandage or is strengthened the circular course, or attached to a tie; the ends of a tie are tied under a chin, strongly holding all bandage.

Fig. 13. A bandage cap (and and — the ends of bandage).

Cross-shaped, or eight-figurative, a bandage on a nape and the tail of a neck (fig. 14): the circular courses (1 and 2) bandage is strengthened around the head, then over the left ear it is lowered slantwise on a neck (3), further around a neck and on a back surface it is returned on the head (4) again. Having carried out bandage through a forehead, repeat the third course (5), then the fourth (6). Further the bandage is continued, repeating the same courses crossing on a nape and fix by two last circular rounds around the head.

Fig. 14. A cross-shaped bandage on a nape and the tail of a neck.

Bandage on one eye. At a bandage on the right eye bandage is held normally and conduct it from left to right (in relation to bandaging). At a bandage on the left eye (fig. 15) it is more convenient to hold a head of bandage in the left hand and to bandage from right to left.

Fig. 15. A bandage on one eye.

Fix by the circular horizontal course through a forehead bandage, then behind lower it on a nape, conduct under an ear with the sick party slantwise through a cheek and up, closing it a sore eye. The slanting course is fixed circular, then again make the slanting move, but is slightly higher previous slanting, and, so alternating circular and slanting tours, close all area of an eye.

Bandage on both eyes. Bandage hold, as usual (fig. 16), fix it by the circular course (i), then lower on a darkness and a forehead and make from top to down the slanting move closing the left eye (2); conduct bandage around a nape under the right ear down, and then make the slanting move from below up closing the right eye (3). These and all subsequent courses (4, 6 and 5, 7 etc.) bandage cross in a nose bridge. The bandage is strengthened the circular course through a forehead.

Fig. 16. A bandage on both eyes.

The bandage supporting a mandible — «halter». Having fixed bandage by the circular horizontal course of 1 (fig. 17), conduct it slantwise to area of a nape (2) on the right side surface of a neck and under a jaw, then up ahead of the left ear, through a cinciput (3) and down ahead of the right ear, under a jaw and a chin. These circular vertical tours (4, 5, 10 and 11) periodically alternate to the horizontal strengthening tours through a forehead (7, 9 and 12) where bandage is carried out on the left side of a neck and a nape (6 and 8) and with horizontal tours through a neck — a chin if it needs to be closed in front. The bandage comes to an end with circular tours through a forehead.

Fig. 17. Options of imposing of a bandage on a mandible.

Neapolitan bandage (fig. 18) on area of one ear and a mastoid, not taking a neck. It is begun with the circular courses and from the sick party lower below and below, covering area of an ear and a mastoid. Fix a bandage by the circular course.

Fig. 18. The Neapolitan bandage on area of an ear and a mastoid.

Bandage on a neck shall be easy, not thick; it is whenever possible necessary to reduce quantity of the circular courses since they are unpleasant to the patient and constrain breath. The cross bandage of a neck is applied as a cross bandage a nape (fig. 14), alternating its courses with circular, through a neck.

During the bandaging of the bottom of a neck or all neck the circular courses supplement with the courses of a cross bandage of a nape and a cross bandage of a back going through axillary area (fig. 19).

Fig. 19. Cross bandage of a neck.

Bandages on a thorax

Fig. 20. A spiral bandage on a thorax.
Fig. 21. A spiral bandage on a thorax with two strips of bandage.

Spiral bandage of a breast. Tear off from bandage a piece length apprx. 1 m and put it the middle on the left shoulder girdle (fig. 20). After that in the direction twist with the spiral courses (3 — 10) all thorax to axillary hollows up and here fix by the circular course. Freely hanging part of bandage (1) is thrown through the right shoulder and connected with the end hanging on spin (2). The spiral bandage will keep stronger if to impose on a strip of bandage on each shoulder girdle. During the binding of strips two straps holding a bandage (fig. 21) turn out.

Crosswise, or star-shaped (fig. 22), a bandage on a breast begins with the circular course fixing bandage around a thorax (1). Then on a front surface of a breast bandage is conducted up in the slanting direction on the right on the left shoulder girdle (2), through a back cross on the right shoulder girdle and lowered slantwise (3) in the left axillary hollow. Then conduct cross through a back in the right axillary hollow, through the left shoulder girdle from here, repeating the second and third courses. The bandage is fixed around a breast.

Fig. 22. Cross bandage: at the left — on a breast; on the right — on a back.

Sometimes apply a cross bandage a back (fig. 22). In this case bandage is fixed by the circular course around the left shoulder girdle, and then slantwise from top to down carried out to the right axillary hollow (2) and, lifting through the right shoulder girdle (3), lower slantwise from top to down in the left axillary hollow. The subsequent courses of bandage (4, 6, 5, 7) are repeated by previous.

Fig. 23. Imposing of the bandage supporting a mammary gland.

The bandage supporting a mammary gland. During the overlaying on the right mammary gland bandage (fig. 23) is conducted usually from left to right, at a bandage on the left gland — in the opposite direction. Begin with the circular courses below a mammary gland (1), reach the spiral courses the right mammary gland, and then, having captured the lower and its interior, conduct bandage on the left shoulder girdle (2), slantwise behind on a back in the right axillary hollow, from here, covering the bottom of gland (3), and further again up (4) through sick gland, repeating the courses — the second etc. Fix a bandage by the circular course below gland.

The bandage supporting both mammary glands, begins (fig. 24), it is similar previous, from a circular turn (1). Having reached the basis of the right gland, bandage is directed slantwise up to the left shoulder girdle (2), then through a back in the slanting direction to the right axillary hollow and on a side surface of a breast passed into the horizontal direction (3). Having passed under the left mammary gland, bandage is conducted slantwise through a back on the right shoulder girdle and lowered (4), in an interval between mammary glands, covering left, and fix by the horizontal courses. All these turns alternate, both glands will not be closed yet.

Fig. 24. Imposing of the bandage supporting both mammary glands.

Dezo's bandage. Having pressed the hand bent in an elbow at right angle (fig. 25) to a trunk do a number of circular rounds through a thorax and a shoulder on all its extent (1) — the first part of a bandage. Its second part is imposed other bandage, having fixed the end of the first on a trunk or having tied up the second bandage by the end of the first. Through an axillary hollow of the healthy party bandage is directed on a front surface of a thorax slantwise to a shoulder girdle of the sick party (2), from here vertically down a back surface of a shoulder under an elbow, then, having bypassed an elbow, behind beforehand through a forearm and a breast in an axillary hollow of the healthy party (3), on a back, slantwise on a shoulder girdle of the sick party and down a front surface of a shoulder (4) from here. Having bypassed an elbow in front back, bandage is conducted through a back in a healthy axillary hollow then repeatedly repeat the second, third and fourth courses. At correctly applied bandage the courses of bandage form a figure of a triangle on spin. The bandage is finished and fixed by the circular courses through a shoulder and a trunk.

Fig. 25. Imposing of a bandage of Dezo.

Dezo's bandage is applied as strengthening and especially to a temporary immobilization at first-aid treatment at a fracture of a clavicle. In these cases before imposing of a bandage on the sick party place the thick wadded and gauze roller that at a hard pribintovyvaniye of a shoulder to a trunk draft for the acromial end of a clavicle was created in an axillary hollow, edges interferes with the shift of its fragments. For Dezo's bandage at the adult man it is spent not less than three wide bandage.

Velyio's bandage. Bandage a hand with the raised elbow and the brush put on a healthy shoulder to a trunk (fig. 26). Bandage is conducted at first horizontally, covering a thorax and a hand (1), in an axillary hollow of the healthy party and transfer on a back slantwise to a sore shoulder (2), on the outer side of a shoulder to an elbow from there, pick up an elbow from below and carry out bandage to an axillary hollow of the healthy party (3). Further all three courses are repeated, and the horizontal courses lay down below previous, vertical — knutr from previous.

Fig. 26. Velpo's bandage.

Bandages

On area of an upper part of a stomach it is possible to apply a simple spiral bandage area of a stomach and a basin, bandaging from below up; the bandage on the bottom of a stomach needs to be fixed on hips.

Spica bandage of a basin. Closes the bottom of a stomach, an upper part of a hip, area of a buttock, an outer surface of an upper third of a hip and a basin and inguinal area (fig. 27). The circular course strengthen bandage around a stomach, then conduct bandage behind beforehand on side and on a front surface of a hip, then lead round a hip behind and in inguinal area cross them the previous course. Lifting bandage on a front surface of a basin, to them lead round a trunk behind and conduct to the inguinal area again, repeating the second and fourth courses. The bandage is fixed by the circular courses around a stomach. Decussation of tours it is necessary to have on one line, at the same time the courses of bandage form the drawing of an ear.

Fig. 27. Spica bandage of a basin

Spica bandage on both groins it nachiatsya by the circular course around a stomach (fig. 28). Bandage is conducted on a front surface of a stomach through the left groin (2), then do the first courses of a spica bandage of the left groin (3). Having bypassed a trunk, do several turns of a spica bandage of the right groin (4 and 5), are returned to the left groin (6 and 7), then again to the right groin (8 and 9) etc. The bandage is strengthened the circular courses around a stomach (14 and 15).

Fig. 28. A spica bandage on both groins

Figure-of-eight bandage on a crotch. If it is necessary to close a crotch, the bandage can be made on the same type, as in fig. 28, but in the beginning it is necessary to make several eight-figurative courses (1, 2,3 and 4) crossing on a crotch around upper parts of hips (fig. 29).

Fig. 29. Imposing of a figure-of-eight bandage on a crotch.

Bandages on an upper extremity

Fig. 30. Spiral bandage of a finger.

Spiral bandage of a finger begins with the circular courses (1) in a wrist (fig. 30), then bandage is conducted slantwise through a back of the hand (2), by the end of a sore finger, and from here spiral turns bandage all finger to the basis (3 — 7), then through a back of the hand (8) bandage is conducted on a wrist where fix (9). If it is necessary to close the end of a finger, the bandage is applied as returned (fig. 31).

Fig. 31. Imposing of the returned bandage of a finger.

Spiral bandage of all fingers has an appearance of a glove (fig. 32). On the left hand the bandage is begun with a little finger, on right — with a thumb.

Fig. 32. Spiral bandage of all fingers.

Figure-of-eight bandage of a thumb it is carried out as kolosovidny (fig. 33). Bandage is strengthened the circular course on a wrist (2), conduct it through a back of the hand to a top (2), from there, spiralno twisting a finger (3), on back, and then on the palmar surface of a wrist, then again by its end etc., rising to the basis of a finger and doing all courses, like the previous courses. The bandage is fixed on a wrist.

Fig. 33. Figure-of-eight bandage of a thumb.

Figure-of-eight bandage of a brush. The brush is bandaged usually as a figure-of-eight bandage (fig. 34). The bandage begins the circular course on a wrist (2). On a back of the hand bandage goes slantwise (2) and passes to a palm, is fixed by the circular course (3) and slantwise on a back of the hand is returned to a wrist (4), crossing the second course. Further the second and fourth courses repeat (5 and 6). Fix a bandage on a wrist (7).

Fig. 34. Figure-of-eight bandage of a brush.

The returned bandage of a brush. Together with fingers the brush is bandaged as the returned bandage (fig. 35). The bandage is begun with two circular courses in a radiocarpal joint (2), then bandage is lowered along a brush (2) and fingers on a palmar surface, bending around the ends of fingers, are returned to a back of the hand (3, 4 and 5) and, overturning bandage (6), impose the circular course around a brush (7). Again bending bandage, conduct it on a palmar surface of a brush and fingers again and, bending around the ends of fingers, again conduct it up and again fix by the circular course around a brush. The bandage is finally fixed by the circular course around a brush.

Fig. 35. Imposing of the returned bandage of a brush.

Bandage on a forearm and an elbow. On a forearm the bandage is put as spiral with excesses (fig. 36). Begin with two-three circular courses, and then the courses of bandage conduct a little more slantwise, than it is necessary for a spiral bandage. Hold with a thumb of the left hand its bottom edge, roll a few head of bandage and bend bandage towards themselves so that its upper edge becomes lower and vice versa. Excesses of bandage should be done on one party and on one line.

Fig. 36. A bandage on a forearm spiral with excesses.

Bandage on an elbow joint impose as turtle at the elbow (fig. 37) bent at an angle.

Fig. 37. A bandage of type turtle on an elbow (the courses 1 and 2 — under a bandage).

Spica bandage on area of a shoulder joint. Bandage goes through a healthy axillary hollow on front side of a breast (fig. 38, 2), passes to a shoulder; having bypassed it on a front, outer and back surface, passes behind in an axillary pole, and from it on a back, through a front and side surface of a shoulder (2) where this course is crossed with previous. Further bandage is conducted on a back in the direction of an axillary hollow of the healthy party. From here repetition of the first course (3) begins, then repeat the second course (4) etc. slightly above.

Fig. 38. Imposing of a spica bandage on area of a shoulder joint.

Bandage on axillary area (fig. 39). Having imposed a dressing material, all axillary area is covered with a layer of cotton wool, and cotton wool passes it for borders, and cover partially upper part of a chest wall from sides and an inner surface of a shoulder in an upper part. Only having strengthened this layer of cotton wool, it is possible to make a bandage of stronger. The bandage is begun with two circular rounds in the lower third of a shoulder (1 — 2), then do several courses of a spica bandage (3 — 9) and conduct the slanting course on a back and a breast through a shoulder girdle of the healthy party to the sick axillary area (10 and 12). Then make the circular move covering a thorax and holding vatu (11 and 13). The last two courses on a thorax — slanting and circular — alternate several times. The bandage is fixed by several courses of a spica bandage of a shoulder.

Fig. 39. A bandage on axillary area.

Bandage on all hand begins in the form of a glove on fingers and proceeds a spiral bandage with excesses to area of a shoulder where passes into simple spiral and comes to an end with a spica bandage (fig. 40).

Fig. 40. A bandage on all hand.

Bandage on stumps of an upper extremity. At amputation of a shoulder the bandage is applied as a spica bandage a shoulder joint with the returned courses of bandage through a stump and is fixed by spiral tours on a shoulder (fig. 41).

Fig. 41. Imposing of a bandage on a stump of a shoulder (as kolosovidny) and forearms.

At amputation of a forearm the bandage begins a circular tour in the lower third of a shoulder, then bandage goes down along a forearm through his stump, is returned up and is fixed by circular tours on a forearm (fig. 41).

Bandages on the lower extremity

Spiral bandage of a thumb of a leg. Separately bandage usually only one thumb, and do a bandage as well as on a hand; strengthen it around anklebones (fig. 42), other fingers close together with all foot.

Fig. 42. Spiral bandage of a thumb of a leg.

Figure-of-eight bandage of foot. To close area of an ankle joint, it is possible to use a bandage as eight-figurative (fig. 43). Begin it with the circular course above anklebones (1), going down obliquely through the back of foot (2); then make the move around foot (3); rising up by a shin (4) on the back it, cross the second course. Cover with such eight-figurative courses all back of foot (5 and 6) and fix by the circular courses around anklebones (7 and 8).

Fig. 43. Figure-of-eight bandage of foot.

Bandage on foot (without bandaging of fingers). Bandage is conducted along foot (2) from a heel (fig. 44) to the basis of fingers. Here make the move around foot; going at first on the back, then, turning on a sole and rising by the back (2) again, cross the previous course. After decussation bandage is conducted on other edge by groans, reaching a heel, bypass it behind and repeat the courses, similar to the first and second. Each new course in a heel passes above previous, decussations do closer to an ankle joint (22, 12).

Fig. 44. Imposing of a bandage on foot (without bandaging of fingers).

The returned bandage of foot. If it is necessary to close all foot, including also fingers, then, having made the circular course (fig. 45) at anklebones, the bandage is continued by the longitudinal courses going from a heel to a thumb on side surfaces of foot. These courses shall be imposed absolutely poorly, without tension. Having made several courses, repeat the previous bandage (fig. 44).

Fig. 45. Imposing of the returned bandage of foot.

Bandage on calcaneal area. The area of a heel can be closed as the dispersing turtle bandage (fig. 46). The bandage is begun with the circular course through the most acting part, then to it add the courses above (2) and below (3) the first. It is desirable to strengthen these courses the slanting course sideways going behind forward and under a sole (4) that then to continue the courses of bandage above and below previous.

Fig. 46. Imposing of a bandage on calcaneal area (as turtle).

Turtle bandage of a knee. It is imposed at a halfbent knee joint (fig. 47). Begin with the circular course through the most vystoyashchy part of a patella (1), then do the similar courses in front serially lower (2, 4, 6 and 8) and above (3, 5, 7 and 9) previous, and behind, almost covering the previous course. At the unbent position of a knee apply a bandage as eight-figurative it, doing circular turns is higher and lower than a knee joint and slanting with decussation in a popliteal space. Area of a shin the bandage is applied as usual spiral with excesses.

Fig. 47. Imposing of a turtle bandage on area of a knee joint: at the left — at a halfbent knee joint and a figure-of-eight bandage, on the right — at the unbent knee joint.

Bandage on area of a hip. Use usually spiral bandage with excesses, strengthening it in an upper third to a basin the courses of a spica bandage.

Bandage on all lower extremity (fig. 48) consists of a combination of the bandages described above.

Fig. 48. A bandage on all lower extremity.

Bandage on a stump of the lower extremity. Such bandages do as returned (fig. 49). For durability it is fixed above a nearby joint. E.g., at amputation of a hip apply the spica bandage occupying the inguinal area, at amputation of a shin fix a bandage above a knee joint etc.

Fig. 49. Imposing of bandages on a stump of a hip: at the left — as returned, on the right — kolosovidny.

The simplified bandages

the Vast majority of the described bintovy bandages can be simplified for economy of material and time.

The simplified bandage of a finger of a hand (fig. 50) is imposed only on a finger, without bandaging a wrist but only tying on it the ends of bandage.

Fig. 50. The simplified bandage of a finger of a hand

The simplified bandage of axillary area: take a small piece of bandage and tie it in the form of slantwise the going tape through a healthy axillary hollow in a shoulder girdle of the sick party (fig. 51). The bandage attached from the front party to this strip is conducted to the axillary area, on spin thrown through a tape and conducted back. Such courses do so much how many it is necessary for deduction of a bandage. It is easy to apply the same bandage in buttocks and a crotch where it is strengthened the strip of bandage going around a belt.

Fig. 51. The simplified bandage on the left axillary area: at the left — in front; on the right — behind.

Patterns of bandages (planimetric bandages). The bandages from triangular or quadrangular pieces of matter and bandage made on special patterns for various parts of a body are very different and convenient (fig. 52 — 56).

Use the bandages on the person consisting of a number of strips and covering area of lips, wings of a nose, partially a forehead (fig. 57). Similar bandages are applied, e.g., at burns if it is not conducted open treatment of a burn. At last, on the person apply bandages in the form of the mask consisting of a rag of matter with openings for eyes, a nose and a mouth and strengthened by means of ties behind.

Fig. 57. The simplified bandage on the person (at the left), on the right — a mask.

For a brush the bandage can be found from a quadrangular rag of matter with openings for four or five fingers (fig. 58).

Fig. 58. The simplified bandage made of cloth for a brush (at the left — a pattern).

Bandages can be found from matter and bandage, shaping it necessary in each separate case, napr, in the form of a sack for a stump. The similar bandage in the form of a sack can be sewed also for a finger; it becomes stronger on a wrist (fig. 59).

Rees - 59. The simplified bandages in the form of a sack: at the left — for a stump; on the right — it is put on a finger.

Bandages mesh knitted

Bandages mesh knitted (hosiery, tubular) — a new type of the soft holding bandages.

Knitted knitting not dismissed grid from elastic threads, from a viscose shtapelya or a cotton allows to prepare tubular as a stocking, circular sleeves or bags of various diameter. The grid is rolled in the form of a roll (fig. 60).

Rolls of a knitted grid are designated by numbers from 2 to 35 according to their width in centimeters.

During the imposing of a bandage on fingers are used number 2, 3; for a brush, a radiocarpal joint, a forearm, a shin and foot — number 5, 7; for a shoulder, a shin and a hip — number 10, 15; for the head, a trunk, a basin and a hip joint — number 25, 35. Imposing of a circular bandage consists not in bandaging, and in putting on of a piece of a bandage on sick area.

Apply hosiery bandages after closing of a wound with wadded and gauze small pillows. From a roll of the corresponding diameter cut off a piece of necessary length. Since fabric, stretching on width, is reduced in length, the cut-off piece shall in 2 and even 3 times to exceed the necessary length of a bandage. After imposing on a wound of a dressing material the piece of a knitted sleeve is collected by an accordion, stretched it is maximum on diameter and put on a sore point as a stocking. The grid is straightened on an affected area of a body, stretched on length or it is spiral. For the prevention of slipping of a bandage of edge of a grid paste to skin kleoly or make an incision strips from edge of a grid and tie the formed tapes around a sick body part.

Thus apply bandages throughout a shin (fig. 61), fingers (fig. 62), a shoulder and a forearm (fig. 63). For cover of fingers completely and during the imposing of a bandage on a stump of an extremity one end of the cut-off piece of a grid is tied and, having stretched the formed sack on diameter, put on fingers (fig. 64). Hold a dressing material of a bandage stronger, fixed above fingers (fig. 65). During the imposing of a bandage on area of humeral and coxofemoral joints it is convenient to fix bandages around a trunk (fig. 66) or a basin (fig. 67). Apply a purse-string bandage (fig. 68 and 69, 1) after cutting an opening for the person the head. Apply a circular bandage with strengthening a thorax its straps or tsirkulyarno the tied tapes (fig. 70) found from a grid. On pelvic area and buttocks the mesh bandage is prepared, cutting out side openings in a grid, and put on it as pants (fig. 71 and 69, 7). The bandage in the form of an undershirt with the cut-through openings for hands (fig. 69, 2) can be applied a thorax. Also after pro-cutting of openings for fingers apply a bandage a brush and several fingers (fig. 69, 3 and 8). Apply a circular bandage elbow and knee joints (fig. of 69,6 N 9). On foot — as a sock (fig. 69, 5), on all brush — in the form of a mitten, on a stump of an extremity — in the form of a bag (fig. 69, 4).

Indications for use of such bandages can be very wide both in polyclinic, and in hospital conditions, especially at mass arrival of victims. Knitted bandages can be used also as a uniform laying during the imposing of plaster bandages. Advantage of such bandages — simplicity of the equipment, speed of imposing, saving of time and an expense of a dressing material, and also lack of restriction of movements of a sick part of a body. Knitted bandages can repeatedly be applied after their washing and sterilization.

Compressing bandages

Compressing bandages can be applied those areas of a body where the prelum does not threaten with disturbance of breath (neck) or blood supplies (an axillary pole).

Adhesive bandage with the tough pilot it can be applied at umbilical hernia at children of chest age.

Bintovy compressing bandage. During the imposing of a bintovy bandage pressure can be created or due to hard bandaging (e.g., a bandage on a knee joint at a hemarthrosis), or by means of the soft pilot (a lump of cotton wool, a roll of the bandage) placed over a wadded and gauze laying. The last reception is convenient to create, e.g., if necessary pressure in a temporal artery. Turnover of bandage conducts over the pilot.

Zinc-gelatinous bandage best of all provides uniform elastic pressure on all circle of the whole segment of an extremity.

A zinc-gelatinous bandage with Unna's paste (see. Bandages ) impose on an extremity after a bathtub. In the presence of hypostasis the extremity is kept in the raised situation for fall of hypostasis. Skin of foot and a shin is greased with warm paste and bandaged gauze bandage. During the bandaging it is impossible to overturn bandage, it is better to make an incision it that pockets were not formed. After secondary greasing by paste impose new tours of bandage, coating each layer, the bandage from 4 — 5 layers of a gauze will not turn out yet. Instead of bandage it is possible to use a filar stocking with the cut-off manual end. A stocking impregnate zinc - gelatinous weight and pull on an extremity. The bandage is changed in 2 — 3 weeks

BY BANDAGES WITH FILMOGENS

the Bandage with filmogens at the same time protects a wound and does not demand additional fixing on a body surface. Synthesizing of special polymeric materials allowed to apply polymers, new, harmless to patients — plastubol (the Hungarian drug), butylmethacrylate with methacrylic to - that and linaetholum — bumetol (domestic drug). It is more convenient to use these drugs in aerosol package (in barrels with sprayers).

The aerosol of polymer is sprayed on a wound and surrounding skin. After evaporation of solvent the protective film is formed. The barrel is held vertically in 25 — 30 cm from the covered surface. The film is formed in several sec. It is desirable to put 3 — 4 layers of polymer, repeating spraying in half-minute after drying of the previous layer. Store a barrel a head down. Solvent easily ignites, and its mix with air is explosive.

Such bandages are shown only in the absence of considerable separated from a wound (microtraumas, superficial burns, etc.). The postoperative wounds which are sewn up tightly can be covered with a protective film without any other bandage. If the wound secret otslaivat a film in the form of bubbles, the last can be cut off, the discharge is removed and spraying of polymer is made again. In 7 — 10 days the film itself departs from skin. If necessary to remove it use the tampons moistened with ether earlier.

Advantage of film coverings — a possibility of observation through a film of a condition of edges of a wound and lack of the unpleasant feelings of tightening of skin inherent to collodion bandages. Besides, the polymer film does not irritate skin.

At open microtraumas after greasing by spirit solution of iodine widely apply also other protective films, in particular from BF-6 glue or B-2 glue with addition of formalin («glue Shkolnikov»).

Protective films can be received also by means of the means containing antiseptic agents and a collodion.



Bibliography Beavers And. The management to studying of surgical bandages, a desmurgy, M., 1882, M., 1915; Velikoretsky A. N. The doctrine about bandages, a desmurgy, M., 1952; it, Bandages, M., 1956; Kutushev F. X., etc. The doctrine about bandages, L., 1974; Turner G. I. The management to imposing of bandages, SPb., 1899, L., 1940; Hakhutov of III. The doctrine about bandages, a desmurgy, Kiev, 1927.

See also bibliogr, to St. Plaster equipment , Immobilization , Bandagings , Bandages , Sheena, splintage .


A. I. Velikoretsky.

Яндекс.Метрика