J. Biomedical Science and Engineering, 2013, 6, 1186-1190 JBiSE
http://dx.doi.org/10.4236/jbise.2013.612148 Published Online December 2013 (http://www.scirp.org/journal/jbise/)
Geometry of the bandaging procedure and its application
while wrapping bandages for treatment of leg ulcers
Monica Puri Sikka*, Subrato Ghosh, Arunangshu Mukhopadhyay
Department of Textile Technology, National Institute of Technology, Jalandhar, India
Received 7 October 2013; revised 15 November 2013; accepted 28 November 2013
Copyright © 2013 Monica Puri Sikka et al. This is an open access article distributed under the Creative Commons Attribution Li-
cense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In
accordance of the Creative Commons Attribution License all Copyrights © 2013 are reserved for SCIRP and the owner of the intel-
lectual property Monica Puri Sikka et al. All Copyright © 2013 are guarded by law and by SCIRP as a guardian.
ABSTRACT
Appropriate compression bandaging is important for
compression therapeutic medical diseases. The high
compression approach employed for treating venous
leg ulcers should be used correctly so that sufficient
(but not excessive) pressure is applied. Bandages used
to treat venous disease by compression should achieve
and sustain effective levels and gradients of pressure
and minimize the risk of pressure trauma. To main-
tain graduated compression on the limb, the bandage
needs to be applied at the same tension for each layer
from the ankle to the knee. In this paper, the geome-
try for various ba ndaging procedures is used to wrap
each layer of bandage by marking the relaxed length
of the bandage. The relaxed length is calculated de-
pending on the stretch%, the average circumference
of the limb to which it is to be applied and the ban-
daging technique to be used. This paper aims at de-
veloping a scientific approach while applying the
bandage to reduce the inter operator variability in
applying the same tension on each successive layer of
bandage.
Keywords: Bandaging; Compression; Inter Operator
Variability; Graduated; Relaxed Length; Stretch
1. INTRODUCTION
Compression therapy is used for the treatment of the ve-
nous leg ulceration and for other chronic venous insuffi-
ciency [1,2]. Compression is provided by wrapping the
bandage around the limb by the application of external
force. Because of compression, the pressure is generated
at the interface between bandage and skin and this pres-
sure is called interface pressure or sub-bandage pressure.
The efficiency of the treatment depends to a great degree
on the level of interface pressure applied and sustenance
of this pressure during the course of the treatment. Pro-
vided that the right level of interface pressure does not
affect arterial flow and the right level of application
technique and materials used, the effects of compression
can be dramatic, which could reduce oedema and pain
and also could promote healing of ulcers caused by ve-
nous insufficiency [3,4]. So compression bandaging re-
quires skill, appropriate training and initial supervision
of practice [5].
The degree of compression produced by any bandage
system over a period of time is determined by complex
interactions between four principle factors—the physical
structure and elastomeric properties of the bandage, the
size and shape of the limb to which it is applied, the skill
and technique of the bandager and the nature of any
physical activity undertaken by the patient [6]. It is es-
sential that practitioners understand how application
techniques can affect the performance of the bandage
systems [7]. Inappropriate selection or application of a
bandage could lead to lack of efficacy and to adverse
effects including amputation [8]. Lee et al. [9] observed
the importance of different application techniques on the
interface pressure variations for different bandages.
Wrapping of bandage over wounded limb by different
practitioners could also influence interface pressure
variation. Dale et al. [10] observed different pressure
gradients obtained by the same bandaging system when
applied by different experienced technicians under the
same application technique.
Many attempts have been made to reduce the effects
of operator variability by marking bandages with geo-
metrical shapes that change from rectangles to squares or
from ovals to circles when a particular level of extension
has been applied [11]. Not all bandages have these geo-
metrical shapes and some manufactures ask users to ap-
*Corresponding author.

M. P. Sikka et al. / J. Biomedical Science and Engineering 6 (2013) 1186-1190 1187
ply medical compression bandages with a percentage of
extension [11]. Without any visual markers, the real
stretch obtained on application of bandage by qualified
personnel can vary from 35% to 70%, leading to a risk of
under or over-application of pressure [12].
The geometrical shapes used for applying the desired
stretch% on the bandages have a few drawbacks. The
change in shape is visual and depends on individual per-
ception, so there is no guarantee that the recommended
stretch% is maintained. Also there is always a range
given by the manufacturer for the pressure values and the
limb circumference for a particular stretch% value. Fur-
thermore, these values are given for only one type of
bandaging procedure that generally spirals 50% overlap.
Finally it has been seen while applying such a type of
bandage that the rectangles change into squares at dif-
ferent stretch values than what is recommended by the
manufacturer.
An experimental set up was done to see the change of
shape on the bandage at different stretch levels as rec-
ommended by the manufacturer for a bandage. The sam-
ple is clamped at two edges and a weight equivalent to
the stretch% value is hung at the bottom and then the
change in shape is observed. The best fit linear equation
for the load elongation curve of the bandage (generated
using Excel) was used to estimate the load for the given
stretch% value (Figure 1). The weights hung according
to the recommended stretch% for green rectangles and
brown rectangles in the bandage reveal that a small
change in weight has no visible effect on the shape but
the corresponding change in stretch% and thus the sub
bandage pressure could be of concern.
To cater to these problems and to provide a scientific
approach to wrap a bandage at a particular level of
stretch for each layer, a geometrical model is proposed.
The model is developed for two commonly used tech-
niques of bandaging i.e. spiral bandaging and ascending
spica or figure of eight bandaging [13].
2. GEOMETRY OF THE BANDAGING
PROCEDURE
The pressure on the limb is developed by the tension in
the bandage fabric and this tension is the result of the
y=0.018x‐ 0.140
R²=0.946
‐1
0
1
2
3
4
050100 150 20
0
Load(kg f )
Extension(%)
Figure 1. Best fit linear equation for the load extension curve
of the bandage.
stretch/force applied in the fabric. To provide a uniform
stretch in each layer, the limb circumference and fabric
thickness are to be linked to the stretch in the fabric for
generating pressure in the limb. When the bandage fabric
is applied layer by layer on the cylindrical body; the cir-
cumference of the cylindrical body increases due to the
fabric thickness so in order to wrap all the layers of ban-
dages with uniform stretch (%), a relationship between
these three parameters is necessary. The relationship has
been formulated [14] and given below. The actual length
of bandage sample in relaxed state (l) is to be stretched to
an extra amount of length to be wrapped on cylindrical
body having circumferential length (c), to get the prede-
fined stretch level (S%) for 100% overlap, which is given
by:

2π1
11
100 100
rn t
c
lss
 




(1)
where n = number of layers of the bandage, t = thickness
of the bandage, r = radius of curvature of the cylinder
surface.
Taking this further and extending to spiral bandaging
and figure of eight bandaging a relationship has been
developed between fabric stretch, circumference of ban-
daging surface and bandage fabric thickness considering
the simplified geometry of the two types of bandaging
techniques. The assumptions taken are:
1) The surface of the cylinder is uniform throughout.
2) The stretch percentage all along the fabric length is
the same.
3) Thickness of the bandage is measured in standard
thickness testing condition.
The spiral bandaging (Figure 2) on a uniform circular
cylinder can be represented geometrically as in Figure 3
and further this cylinder is flat opened (Figure 4).
Figure 2. Spiral bandaging [13].

M. P. Sikka et al. / J. Biomedical Science and Engineering 6 (2013) 1186-1190 1188
Figure 3. Geometry of spiral bandaging.
Figure 4. Flattened cylindrical view for spiral bandaging.
where c = circumference of the cylindrical body in “cm”,
d = diameter of the cylinder, t = thickness of the bandage
in “cm”, r = radius of curvature of the cylinder surface, w
= width of bandage in “cm”.
Now considering the triangle CBD (Figure 4), the
circumferential length (L) can be expressed as:
2
cose1ccoLc c  t

 (2)
where θ = angle of bandaging, c = circumference = πd.
When the bandage of width “w” cm is wrapped spi-
rally with 50% overlap, from the triangle CBD (Figure
4).
tan 2
2
cot 2
ccw
w
wc




(3)
Putting the value of cot θ from Eq.3 in Eq.2

2
22
12
14
2
Lc wc
Lcw


(4)
Similarly for spiral 66% overlap, tan 3cw

, so
2
19
3
Lc
2
w
(5)
And for spiral 100% overlap since θ = 90˚, cot θ = 0,
hence L = c.
For spiral bandaging both 50% and 66% overlap “c” is
replaced by the new circumferential length “L” in Eq.1.
Substituting the value of L from Eq.4 in Eq.1, actual
length of bandage fabric (l) to be taken in relaxed state to
apply it spirally at 50% overlap at the predefined stretch
level can be calculated in terms of r, n, t, w, S which are
the known parameters to generate a particular stretch
value Eq.6.
 
2
22
2
124 2π
14
2
11
100
1
100
100
1
c
rn
w
L
lss
tw
S

 






(6)
Similarly the length of bandage fabric (l) in relaxed
state to be taken to apply it spirally at 66% overlap and
any predefined stretch level can be calculated in terms of
r, n, t ,w, S from Eq.7
22
19
3
11
100 100
cw
L
lSS



So


22
1392π1
1100
rn tw
lS

 



(7)
To calculate the length of bandage fabric (l) in relaxed
state for figure of eight bandaging technique, let the ban-
dage be applied in figure of eight at 50% overlap (Figure
5). Figure 6 is the geometrical representation of the fig-
ure of eight bandaging technique on a uniform circular
cylindrical limb. When the cylinder is flat opened, it can
be represented as shown in the Figure 7.
Figure 5. Figure of eight bandaging [13].
Overlap
A, A'B, B'
p
Figure 6. Geometry for figure of eight bandaging.

M. P. Sikka et al. / J. Biomedical Science and Engineering 6 (2013) 1186-1190 1189
From the triangle QA’R in Figure 7 bandage to be wrapped on a given limb to maintain a
particular stretch for a given circumference and number
of layers depending on different bandaging techniques.
To illustrate this, the value of relaxed length “l” is calcu-
lated layer wise using different values of stretch% and
the number of layers for different types of bandaging
techniques taking 38.5 cm circumference of the leg and
0.834 mm bandage thickness according to the Eq.6, 7
and 9.

22
42 2Lp c
2
where L = new circumferential length, w = width of the
bandage, p = spacing between the two extreme turns of
the bandage and its value is always between w and 2w
22
22
2
2
244
16 44
2
Lpc
Lpc
Lpc



2
(8) It is observed from the Table 1 that the relaxed length
is much less than the actual circumferential length and it
decreases further with increase in stretch value. Also as
the number of layer increases, the bandaging circumfer-
ence also increases and corresponding to this circumfer-
ence, the relaxed length of bandage sample “l” also in-
creases at various stretch levels to get uniform stretch for
each layer. This calculated relaxed length can be now
marked on the bandage and wrapped layer wise to get the
desired stretch% at each layer.
For figure of eight bandaging 50% overlap “c” in Eq.1
is replaced by the new circumferential length “L”. Now
putting the value of “L” from Eq.8 in Eq.1, the actual
length of bandage fabric (l) in relaxed state to be applied
in figure of eight at 50% overlap is given by:
 
2
2
1100
22π1
1100
L
lS
prnt
lS







(9) 4. CONCLUSIONS
Practitioners require guidelines to follow that are evi-
dence-based, relate to local needs and are easy to follow.
The current compression therapy techniques do not pro-
vide users with sufficient and accurate feedback con-
cerning the interface pressures applied by them. More-
over the geometrical shapes provided on the bandages by
the manufacturers give a range of pressure values for a
stretch% for one type of bandaging procedure (generally
spiral 50% overlap). Also it is observed that these shape
changes are dependant on individual visual perception.
The value of p for figure of eight bandaging with 50%
overlap as experimentally measured after application is
one and a half times (1.5) the width of the bandage. The
second overlap in figure of eight bandage is exactly half-
way the width of the first bandage overlap in addition to
one full width of the bandage.
3. APPLICATION OF THE
GEOMETRICAL MODEL IN
BANDAGING PRACTICE
To deal with these intricacies, this model has been de-
veloped based on the geometry of bandaging procedure
which will not only effectively reduce the problem of
inter operator variability during wrapping but also will The geometrical model calculates the relaxed length of
Figure 7. Flattened cylindrical view for figure of eight bandaging.
Table 1. Relaxed length of bandage layers for various bandaging techniques.
Relaxed length of bandage “l”
for spiral 50% overlap (cm)
Relaxed length of bandage “l”
for spiral 66% overlap (cm)
Relaxed length of bandage “l” for
figure of eight 50% overlap (cm)
Stretch (%)
First layer Second layer First layer Second layer Third layerFirst and second
layer
Third and fourth
layer
30% 29.86 30.26 29.72 30.11 30.52 31.78 32.15
40% 27.73 28.10 27.60 27.95 28.34 29.51 29.86
50% 25.88 26.22 25.76 26.09 26.45 27.54 27.87

M. P. Sikka et al. / J. Biomedical Science and Engineering 6 (2013) 1186-1190 1190
cater to the need for generating graduated and consistent
level of compression. The model has been developed
with an intention to follow an appropriate bandaging
process according to the desired stretch% and the ban-
daging technique to be used.
REFERENCES
[1] Farah, R.S. and Davis, M.D.P. (2010) Venous leg ulcera-
tions: A treatment updates. Current Treatment Options in
Cardiovascular Medicine, 12, 101-116.
http://dx.doi.org/10.1007/s11936-010-0066-9
[2] Vicaretti, M. (2010) Compression therapy for venous dis-
ease. Australian Prescriber, 33, 186-190.
[3] Clark, M. (2003) Compression bandages: Principles and
definitions. Position Document, European Wound Man-
agement Association (EWMA), Medical Education Part-
nership Ltd., London, 2-4.
[4] Mosti, G., Mattaliano, V., Polignano, R. and Masina, M.
(2009) Compression therapy in the treatment of leg ulcers,
Acta Vulnologica, 7, 1-43.
[5] Nelson, E., et al. (1996) The management of leg ulcers.
Journal of Wound Care, 5, 73-76.
[6] EWMA Position Document (2003) Understanding com-
pression therapy. MEP, London.
http://www.proguide.net
[7] Logan, R.A., Thomas, S. and Harding, E.F. (1992) A
comparison of sub bandage pressures produced by ex-
perienced and inexperienced bandagers. Journal of Wound
Care, 1, 23-26.
[8] Thomas S, Nelson AE. (1998) Graduated external com-
pression in the treatment of venous disease. Journal of
Wound Care, 78, 1-4.
[9] Lee, A.J., Dale, J.J., Ruckley, C.V., Gibson, B., Prescott,
R.J. and Brown, D. (2006) Compression therapy: Effects
of posture and application techniques on initial pressures
delivered by bandages of different physical properties.
European Journal of Vascular and Endovascular Surgery,
31, 542-552. http://dx.doi.org/10.1016/j.ejvs.2005.10.023
[10] Dale, J.J., Ruckley, C.V., Gibson, B., Brown, D., Lee, A.J.
and Prescott, R.J. (2004) Multi-layer compression: Com-
parison of four different four-layer bandage systems ap-
plied to the leg. European Journal of Vascular and En-
dovascular Surgery, 27, 94-99.
http://dx.doi.org/10.1016/j.ejvs.2003.10.014
[11] Thomas, S. and Fram, P. (2003) An evaluation of a new
type of compression bandaging system.
www.worldwidewounds.com
[12] (2010) www.urgomedical.com
[13] Compression Therapy Study Group (2009) Compression,
consensus document based on scientific evidence and
clinical experience. Edizioni Minerva Medica Torino,
Compression impa.indd 3.
[14] Venkata, P. (2011) Experimental and theoretical studies
on compressive behaviour of crepe bandage fabrics.
M.Tech thesis, N.I.T-Jalandhar, 1-60.