Adapa Nikhil, Goyal Kanu S
1 The Ohio State University College of Medicine, Columbus, USA.
2 The Ohio State University Wexner Medical Center, Columbus, USA.
Hand (N Y). 2019 Jan;14(1):48-55. doi: 10.1177/1558944718799391. Epub 2018 Sep 6.
We tested how different applications of casts and splints affect underlying below-dressing pressures and how these dressings respond to swelling.
A 3-in polyvinyl chloride pipe with an attached 100 mL saline bag to the outer surface was used to simulate a human forearm. A pressure transducer was attached to the bag and connected to a monitor providing continuous pressure measurements. Either a circumferential fiberglass cast or single-sided plaster splint was applied around the bag. To simulate the dressing's compliance to soft tissue swelling, change in pressure was measured after 25 mL of saline was injected into the bag. Compliance was determined by calculating change in volume over change in pressure as volume was added.
In our 150 mL model, cast bivalving reduced pressure up to 28%, and splitting the cotton padding of a splint reduced pressures up to 33%. The mean compliance (ability to accommodate swelling) across all volume intervals was 182% greater in a bivalved cast versus a cast and 21% greater in a cotton-split splint versus a splint. Below-dressing pressure of a tightly wrapped elastic bandage was up to 2.76× greater than a medium tension bandage and up to 6.44× greater than a loosely applied bandage. A splint with real cotton padding had a 28% greater pressure than a splint with synthetic soft-roll padding.
Splitting a dressing, utilizing synthetic cotton padding, and applying an elastic bandage cautiously can help reduce surface pressures and allow the construct to be more accommodating to soft tissue swelling.
我们测试了不同类型的石膏和夹板应用如何影响敷料下方的压力，以及这些敷料对肿胀的反应。
使用一根3英寸的聚氯乙烯管，其外表面附有一个100毫升的盐水袋来模拟人体前臂。一个压力传感器连接到袋子上，并与一个提供连续压力测量的监视器相连。在袋子周围应用环形玻璃纤维石膏或单侧石膏夹板。为了模拟敷料对软组织肿胀的顺应性，在向袋子中注入25毫升盐水后测量压力变化。顺应性通过计算随着体积增加压力变化时的体积变化来确定。
在我们的150毫升模型中，石膏切开减压可达28%，夹板的棉垫撕开减压可达33%。在所有体积区间内，切开的石膏的平均顺应性（适应肿胀的能力）比完整石膏高182%，棉垫撕开的夹板比完整夹板高21%。紧密包裹的弹性绷带的敷料下压力比中等张力绷带高2.76倍，比宽松应用的绷带高6.44倍。带有真正棉垫的夹板比带有合成软卷垫的夹板压力高28%。
撕开敷料、使用合成棉垫并谨慎应用弹性绷带有助于降低表面压力，并使结构更能适应软组织肿胀。
