Above Knee Stump BandagingG F Lamb, NZ Artificial Limb Board

effective bandage material – I prefer Seton Elset ‘S’

effective bandage size –15cm, or for larger stumps 2 x 15cm bandages sewn end to end

the bandaging to extend above the hip joint to provide low tension suspension

learning to keep the bandage always applied to the leg; lifting it off creates bad tension lines

all tensioning turns to be long spirals

a conical pressure gradient on the stump

the avoidance of congestion in the stump; congestion causes swelling and PAIN

fixation of the bandage with several safety pins, NOT adhesive tape. Safety pins ‘sew’ thebandage layers together, so help to maintain the shape achieved.

Successful shaping of a stump by bandaging requires:

START the bandage at thecontralateral loin.Take an anchoring turnaround the waist.

The bandage now travels down over the buttock tothe lateral side of the stump spiralling towards thefront pulling the stump into full extension at the hip,reaching the medial aspect of the distal stump.

This turn is not specifically tensioned but provides agood surface for later turns to slide on.

A turn around the stumpthen spirals back up thestump towards the groinand under the perineumemerging on the buttockwhere it crosses theoriginal bandage.

It then travels around thewaist as a suspensory turnuntil it descends over thebuttock of the amputatedside once more and spiralsdown the stump. This turnis beginning to apply tensionover the distal part of thestump by paying out lessbandage than the distancecovered. It is essential thatthe bandage be kept fullyapplied to the stumpthroughout to avoid uneventension lines. At the stumptip only about 2/3 of thewidth is applied to thestump. The remaining thirdwill automatically close inover the end of the stump.

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Position: Bandaging is mosteffectively done with thepatient standing on the otherleg, and supported by holdingon to furniture etc.

The bandager is best kneelingbehind the patient on theamputated side at 45° to thecoronal plane.

Nb. Bandaging over underclothing is donein this poster for demonstration purposesonly. In practice above knee bandagingneeds to be done with the patient nakedso that underclothing can be worn andremoved without affecting the bandage.

The bandage is then spiralled up to the hip asbefore and the whole sequence repeated varyingthe precise route of the turns to achieve theshaping required until all the bandage is used.

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PAIN = CONGESTION, soTAKE THE BANDAGE OFF.Tell the amputee that their bandage should feel

firm but never painful.

The bandage is then secured with 2 or 3 safety pinswhich act to sew the layers of the bandage togetherby catching all layers. The pins work best at crossover points of the bandage but beware leaving themplaced so as to make lying or sitting miserable.

CHECK that the bandage tension is graded, maximaldistally and reducing from there proximally. CHECKthat the bandaging has shaped the stump asintended. CHECK that the waist anchoring turns areloose enough to get a hand under comfortably (mostimportant). CHECK that the hip is free to move fromfull extension to 90°.

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It is important to ensure that

a) the hip joint is kept extended throughout

b) at least one turn of the bandage reaches up into the perineum and one turn right up to thegroin crease to avoid the production of fat rollsin those susceptible places.

PAIN = CONGESTION, soTAKE THE BANDAGE OFF.

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