Transcript
Stephanie Woelfel, PT, DPT, CWS
So I want to discuss a little bit about how to make your dressings conform a little bit better, especially when we're working on a curved surface like we have around the ankle or the calf. And this is especially important if you're putting your patients into a compression wrap or something like that. You don't want any bunches or rolls underneath there that could potentially cause another wound area or make the dressing as a whole more uncomfortable for your patient. So there's a few things that you can do and you can kind of see the issue here, right? If I'm trying to get this around her leg, it's bunchy, it's gappy, and that isn't going to sit really well underneath compression. So kind of a really easy trick that you can do is just use a scissors to just cut little slits all the way around your dressing.
And for most of your dressings, whether it's a primary dressing or a secondary dressing, this isn't going to do anything to impact the integrity or the function of the dressing itself. So that really isn't a problem. And then when I go ahead with these little slits, I go ahead and apply this dressing again. You can see that that gives this dressing enough room to now conform and lay much flatter against the skin. So if I was going to do a compression wrap or anything over the top of it, it's gonna have a nice kind of flat surface for the compression to go over, it shouldn't bunch up, and shouldn't be uncomfortable for the patient.
So now, similarly, if I'm trying to conform a dressing again to kind of a rounded surface, for me as a physical therapist I think this is important because I want my patients to be able to get their shoe gear on, safe shoe gear and also not have something that they're stepping on or walking on that's going to be uncomfortable for them or potentially cause another wound area. So if I have a situation where I may be trying to get over a malleolar area, What I might do is just go ahead and on a border dressing, just kind of make some cuts on the corners here, because that's gonna give me a little bit more flexibility when I go to put my dressing on, that I can now kind of conform this a little bit. I can help this one overlap slightly. This one can pull apart a little. So it again just lets me kind of lay my dressing down a little bit flatter. And ideally what I like to do when I'm crossing a joint like this is I like to put the dressing on so I actually would have had her stretch a little more. Looks like it worked out okay for this application.
But I will typically have the patient be kind of at the most open range of motion so that it allows the dressing to then move with them throughout the day. So if I put this on in a shortened position and then the patient starts to move it can disrupt the dressing and then all of a sudden they think, "oh my gosh how do I get this back in place." So really making sure that you have that area of the the body kind of on stretch or kind of at its largest range of motion when you apply the dressing helps make sure that they can go through the full excursion of their range of motion without a) the dressing limiting that, or b) the dressing being disrupted.
All right, so one other trick I have or tip I have is if you are working with an ABD pad, let's say that you need to use some padding or just some additional absorbency for a patient, maybe you're providing instructions for home health or even the patient's family to do this as kind of an added secondary dressing. This can be really tough when you're trying to conform to someone's heel. So if this is a heel wound and I'm bunching this all up under here and then expecting the patient to walk on it and think they're going to be able to do that comfortably, that's probably not going to happen. So what I like to do in this situation is basically make your ABD pad into what looks like a diaper. So anyone that told you that cutting and pasting in kindergarten doesn't pay off, never did wound care because we do this kind of stuff all the time, right? So if I just cut those two little edges out, when I open this now it looks kind of like a baby diaper, but the great thing about this is that that this is gonna conform a lot better now to her heel. And I can now wrap this or whatever I'm going to do, but it makes sure that I don't have all of this bunchy dressing that she's gonna walk on and that that's going to be uncomfortable. This kind of a configuration also works really well if you're wrapping someone that has a transmetatarsal amputation.
Similarly, let's pretend you run into that scenario where you get a whole lot of bulk if you have this ABD pad hole. By cutting it this way, it again allows you to kind of lay these edges flat and then come up again giving the patient a nice flat smooth surface that they can be walking and weight bearing on.
