Edema, commonly known as swelling, occurs when excess fluid accumulates in the body’s tissues, most often noticeable in the legs, ankles, and feet. This fluid retention can cause discomfort, skin changes, and reduced mobility. Compression wrapping is a primary method used to manage this condition by applying external pressure to the affected limb. The objective is to reduce existing swelling and prevent further fluid from pooling in the lower extremities. The wraps encourage the trapped fluid to return to the circulatory and lymphatic systems for proper drainage.
Understanding Compression Materials
The effectiveness of leg wrapping for edema depends on the type of bandage used, categorized by stretch properties: short-stretch and long-stretch. Short-stretch bandages, woven mainly from cotton fibers, have limited elasticity, extending only about 30% to 60% of their original length. This low extensibility results in low resting pressure but high working pressure when muscles contract during movement. This high working pressure aids the muscle pump in pushing fluid out of the limb, making short-stretch bandages the preferred choice for the initial reduction phase of edema.
In contrast, long-stretch bandages contain elastic materials, stretch over 100%, and exert high resting pressure, which is difficult to tolerate, especially at night. Accessory materials are also necessary to protect the skin and shape the limb. These include tubular gauze or stockinette worn directly against the skin, and soft padding used to cover bony prominences and create an even surface.
Essential Preparation Before Wrapping
Before wrapping, prepare the skin and the environment. Start by thoroughly cleansing the leg with mild soap and water, paying special attention to fully dry the skin, especially between the toes and within skin folds, as moisture can lead to irritation or infection. Once dry, apply a pH-neutral, unscented moisturizer to prevent dryness. This is then covered by a tubular cotton stockinette, which provides a protective layer and prevents lotion from getting onto the bandages. The stockinette should extend from the base of the toes up to the top of the planned wrapping area.
Inspecting the Limb
A visual inspection of the entire limb is necessary to check for any cuts, sores, blisters, or signs of infection, such as redness or increased warmth. If open wounds are present, they must be cleaned and covered with a sterile dressing before compression is applied. Finally, the limb should be positioned comfortably, ideally elevated. All required supplies, including padding, bandages, and tape, should be gathered and within easy reach to ensure a smooth application.
Step-by-Step Application Technique
The application of bandages must follow a specific sequence to create the necessary pressure gradient for fluid removal. The wrapping process always begins at the most distant point of the limb—the base of the toes—and moves toward the body (distal-to-proximal). The foot is wrapped first, often using a figure-eight pattern around the ankle and heel to secure the dressing and maintain a 90-degree ankle angle. Maintaining this right angle prevents the wraps from pinching or slipping down.
Wrapping the Leg
Once the foot is covered, continue wrapping up the leg using a spiral or herringbone pattern. Ensure that each layer of the bandage overlaps the previous one by approximately 50%. This consistent half-overlap creates uniform pressure across the limb and prevents gaps or wrinkles that could cause skin damage. The highest tension should be applied around the ankle and foot, gradually decreasing as the wrapping moves up the calf toward the knee. This graduated compression ensures fluid is continuously pushed upward and away from the swollen area.
Finishing the Wrap
Special attention should be given to bony areas like the shin and the back of the knee, which require extra padding underneath the compression layer. The final layer of the bandage should end just below the knee crease to avoid restricting movement or circulation. Secure the end of the bandage with tape, ensuring the tape adheres only to the bandage material and not directly to the skin. The goal is to create a firm, smooth column of pressure that supports the underlying tissues.
Monitoring and Safety Guidelines
Monitoring the leg immediately after and while the wraps are worn ensures safety and effectiveness. A properly applied wrap should feel firm but not painful or excessively tight. After application, check the toes for signs of impaired circulation, such as a change in color (paleness or blue tint), coldness, numbness, or tingling. These symptoms suggest the wrap is too tight and should be immediately removed and reapplied with less tension.
Daily Care and Inspection
For the initial reduction phase of edema, wraps are often worn for 22 to 24 hours a day, only being removed for skin care and showering. The skin should be inspected daily when the wraps are changed, looking for pressure marks, blistering, or signs of skin breakdown. If the wraps become wet, wrinkled, or start to slip down, they must be removed and replaced, as these issues compromise the intended pressure distribution. Any persistent discomfort, increased pain, or signs of infection requires immediate consultation with a healthcare professional.