Practical Pearls

The Universal Dermatology Bandage Kit: A Succinct Collection of Supplies

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Biopsies, excisions, and other invasive cutaneous procedures are daily occurrences in dermatology clinics. Each procedure requires subsequent placement of a bandage; physicians can be left with an overwhelming choice of supplies for this purpose. We present a universal bandage kit as a resource for physicians in search of a concise guide for purchasing materials and educating nursing staff. These few supplies meet all bandaging needs that arise in a dermatology clinic.


 

References

Practice Gap

Biopsies, excisions, and other invasive cutaneous procedures are performed regularly in dermatology clinics and require placement of a bandage after the procedure. Postprocedural bandaging varies by the type of procedure performed, anatomic site, and the physician’s preference of materials. Dermatologists can be left with an overwhelming choice of supplies and little practical education, as bandaging methods are not routinely addressed in residency curricula. To address this concern, we provide a succinct list of basic materials that are versatile and easily adapted to encompass all bandaging needs for dermatology procedures (Table).

Components of the Bandage Kit

With these few components, one can create an array of distinct bandages to cover wounds as small as a shave biopsy to linear closures and basic flaps or grafts. Even traditionally difficult-to-bandage areas are easily addressed. Simple modifications of the basic materials are required for each bandage adaptation, as outlined below.

The Techniques

Shave and Punch Biopsy Sites—Layer (from bottom to top) the emollient of choice, a cut 4×4-inch gauze pad, and flexible polyester tape cut to the appropriate size (Figure 1). This simple bandage conforms well to any anatomic site and can replace an adhesive bandage, if desired.

Bandage on a biopsy site.

FIGURE 1. Bandage on a biopsy site.

Cutaneous Surgery Sites—Pressure bandages are recommended on cutaneous surgery sites. One of the most common closures performed in dermatology is the layered closure with dissolvable subcutaneous sutures and nondissolvable cutaneous sutures. When this closure is performed on the trunk and proximal extremities, undermining often is required to adequately approximate skin. This technique eliminates tension on the wound but can increase the risk for hematoma.1 A pressure bandage left in place and kept dry for 48 hours after surgery helps eliminate the risk for postoperative bleeding.

To make a pressure bandage, layer (from bottom to top) the emollient of choice, a nonstick pad cut to size, folded 4×4-inch gauze pads, and flexible polyester tape (Figure 2). Our practice routinely utilizes the tape fanning technique2 to impart equal and firm pressure over the wound.

Pressure bandage on the trunk following excision and intermediate linear repair.

FIGURE 2. Pressure bandage on the trunk following excision and intermediate linear repair.

Complex Sites—When making a pressure bandage for an anatomically complex site—the ear, nose, or lip—nonstick pads and 4×4-inch gauze pads can be cut and folded or rolled to match the size and shape of the wound. Flexible polyester tape then conforms to these custom bandage shapes, allowing maintenance of targeted wound pressure (Figure 3).

Pressure bandage on the ear, a traditionally hard-tobandage site. The elasticity of the tape conforms to the helical rim.

FIGURE 3. Pressure bandage on the ear, a traditionally hard-tobandage site. The elasticity of the tape conforms to the helical rim.

Dental rolls can be of assistance on these sites. For example, a dental roll placed in the postauricular sulcus prior to bandaging an ear maintains comfortable anatomic positioning. Rolls can be placed in the nose, maintaining its architecture while the wound heals and providing counterpressure for added hemostasis of wounds on the lateral nasal sidewall and ala. We recommend coating dental rolls in petrolatum prior to placement in the nares for ease of removal and patient comfort.

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