Reviewed by Dr. Keith Harding
Four-layer bandaging is a compression bandaging method that achieves better healing rates than traditional compression bandaging. This compression bandage involves applying four different bandage layers with distinct properties and wrapping them in a proscribed manner that cumulatively provides dependable and uniform compression support.
The first layer of four-layer bandaging is usually a soft wool layer that absorbs exudate and protects the bony prominences. The second layer is a crepe bandage that adds absorbency to the wool layer and helps smooth the first-layer wrapping. The third layer provides compression, and the fourth layer provides additional compression and adhesion.
Before applying the four-layer compression bandage, the clinician will thoroughly cleanse the wound and apply the appropriate topical dressing.
The clinician applies the bandages in the following proscribed manner. First, he positions the foot at a right angle. If the foot is extended with the toe pointed when the clinician applies the bandages, it may cause pressure areas to develop in the ankle.
First, the clinician applies the soft wool, or protective layer, in the pattern of a spiral, starting at the base of the toes and moving towards the heel. The clinician stabilizes the wrap by using a spiral pattern of wrapping the wool around the foot. The wool should be wrapped without tension, and each turn should overlap by fifty percent, meaning that half of the wool doubles on top of the previous turn’s wrap, while half moves onto the adjacent part of the foot.
Next the clinician wraps the back of the heel, circling back to the base of the foot in the pattern of a figure eight. It is important to completely cover the heel, because any area of the heel left unexposed may swell. Once the clinician has covered the heel, he should continue to wrap the ankle and leg in a spiral fashion, overlapping each turn by 50%, or half the width of the wrap. Wrapping the leg evenly is really important because it provides uniform pressure support. However, it is important to remember to avoid applying tension.
The clinician applies the second layer, which is a comfortable bandage, utilizing the same technique as the first layer, again making sure to use 50% overlap, and neutral tension.
The clinician applies the third layer, which is a long stretch compression bandage, utilizing the figure eight technique alone. He begins by anchoring the wrap at the base of the toes. Next, he wraps the bandage around the back of the heel, stretching it to 50% tension. He holds the tension in the dressing for the entire application of the third layer. Repeat the figure eight for each layer proceeding up the leg. Be sure each layer overlaps the previous one by 50%.
Finally, the clinician applies the fourth layer, a self-adhesive spiral wrap, utilizing the spiral wrap of the first and second layers. When applying the fourth layer, maintain the 50% overlap, and 50% tension.
If you experience increased pain, numbness or tingling, or if the dressing slips down significantly, call your health care provider. Finally, take precautions to prevent your compression bandage from getting wet. If your health care professional approves of exercise, you should take walks, as walking can help dissipate swelling. If not, do foot exercises by flexing and pointing the foot. Try to avoid sitting for prolonged periods of time. Also, elevate your legs above your heart, particularly if the bandage feels like it is getting tighter.
Last updated: 19-May-04