Guide to Compression Bandages

Lymphedema      |    Types of Compression Bandages     |    Application     |    Unna Boot Bandages

Many times an injury will require the need for a compression bandage. These injuries can be as simple as a sprained wrist or ankle which would require the joint to be immobilized or something as complicated as lymphedema therapy. The identification of which type of compression dressing to use is important in order to facilitate quick healing and prevent pain, infection, or even autonomic dysreflexia. Even though all compression bandages do basically the same thing, there are subtle differences that make one type of bandage preferable over another.

Guide to Compression Bandages

What is Lymphedema?

Lymphedema is a condition of localized fluid retention due to a compromised lymphatic system and leads to tissue swelling. Lymphedema can be hereditary or a result of a damaged lymphatic system due to cancer treatments. The condition is treated by manual compression lymphatic massage and compression garments or bandaging. A certified lymphedema therapist will use a series of elastic bandages to reduce the swelling and help the circulation of built-up fluid throughout the body.

Types of Compression Bandages

2 Layer Compression Bandages

The Inner or contact layer is for patient comfort and absorbency and is typically made of gauze or foam. Specialized systems may be impregnated with solutions to promote healing The second layer is the compression layer and maybe made of a cohesive or self-adhering material.

3 Layer Compression Bandages

Indicated for mixed etiology ulcers or for patients who cannot tolerate high levels of compression. Similar to the 2 compression system the inner layer will be a padded dressing. The second layer will be a conforming dressing for increased comfort in hard to bandage areas. The third layer is the compression layer may be made of a cohesive or self-adhering material.

4 Layer Compression Bandages

Similar to 2 and 3 layer compression but will include an additional thin conforming dressing to provide a uniform surface for the 3rd and 4th layers.

Single Layer / Specialty Compression Bandage

The single-layer dressing will have the absorbent/comfort contact layer covered with a self-adherent compression matrix.


Based on the stretching properties, there are two types of compression bandages, namely, long stretch bandages and short-stretch bandages. They are explained below:

Long Stretch Compression BandagesLong Stretch Compression Bandages

Long stretch bandages have long stretching properties. This means their compressive properties can be adjusted easily. These bandages have a high resting pressure, therefore should be removed at night or while at rest. This type of bandage is usually made from elastic (latex or latex free) and utilizes either a metal clip or a Velcro method to secure it after wrapping it around the injured area. These are commonly known as ace bandages and come in a variety of widths, making it simple to choose depending on the area affected. Long stretch elastic bandages can be used for a variety of injuries, either immobilizing a joint (such as an elbow, knee, ankle, or wrist) or applying compression to a pulled muscle usually related to the athletic activity. Some incorporate an antimicrobial material while others are washable for sanitary reasons.

Short Stretch Compression BandagesShort Stretch Compression Bandages

Short stretch bandages are minimally elastic. They provide high working pressures and lower resting pressures. They are used to control swelling in limbs. This kind of bandage puts pressure on the skin and muscles to improve absorption of fluids. As opposed to long stretch bandages, short stretch bandaging technique provides a massaging effect on muscles. Usually, these bandages are rated at around 70%, meaning they stretch only about 70% of their length. Short stretch bandages are often used as one layer in a system of three or four layers for compression treatment in patients with chronic swelling, such as lymphedema or venous ulcers. Some common brands are Comprilan, Rosidal, and Isoband. These bandages are washable so they can be used more than once.

Compression Bandage Systems

Multi layer compression wraps utilize a series of bandages for protection and compression predominately in the treatment of venous ulcers. For example, the Profore multilayer system utilizes four different bandages, a padding bandage, a conformable dressing, a compression bandage, and a cohesive bandage. These all work together to facilitate a proper healing environment. These elastic layers achieve a sustained level of compression over time.

Application of Four-Layer Compression Bandaging (Ankle Circumference 18-25cm)



Bandage Characteristics






 Orthopedic   Wool 

Absorbs exudate.

Redistributes pressure around limb 

Orthopaedic wool with varying levels of conformability and compressed thickness 

Apply padding to the base of toes. Pad tender area over the dorsum of foot 

Ensures Achilles tendon well covered 

Ensure even application of 2 layers of padding 

Use extra padding to protect bony prominences. Recontour limb with loss of calf muscle. Avoid excessive padding which reduces pressure 

Density and conformability of different products varies. The extra pad of foam over post malleolar area useful to increase pressure over ulcerated areas 

 Cotton   Crepe 

Adds absorbency. Smooths orthopedic wool.

Preserves elastic energy (no compression) 

Light support bandage. Unable to apply high levels of compression. Least effective layer 

Bandage from base of toes using tension to ensure smooth surface on which to apply elastic layers 

Cover all padding to avoid excessive bulk 

Continue with 50% overlap up the limb 

Second bandage not required unless excessively tall patient 

Some 4 layer systems incorporate bandages with elastomeric fibres which may offer higher levels of pressure than cotton-based products. Check bandage specification 

 Elastic,   Extensible   Bandage 

First layer of elastic compression sub-bandage (pressure at ankle 17mmHg) 

Light compression able to apply and maintain pressures up to approx. 20mmHg on ankle circumference (18-25cm) 

Begin extension from base of toes with 2 anchoring turns at 50% extension 

Apply figure of 8 using a high and then low turn to avoid excess layers over dorsum of foot 

Apply in a figure of 8 with 50% extension and overlap 

Reduced pressure can be achieved by applying bandage in a spiral. Increased overlap will increase the pressure 

Bandage extensibility ranges considerably within this group 

 Cohesive   Bandage 

Second layer of compression adds remaining 23mmHg of pressure. Cohesiveness retains bandage position 

Cohesive, elastic bandage able to apply pressures up to approx. 25mmHg on ankle circumference (18-25 cm) 

Applied in a spiral 

Apply figure of 8 around ankle with a high and low turn. Avoid over-extension at front of foot 

Bandage using 50% extension. 50% overlap using spiral technique 

In 'champagne' shaped limbs with increased diameter use figure of 8 technique. This can increase pressure and prevent slippage 

Variations in extension possible.

Non-latex cohesive used in some systems 

Unna Boot Bandages

When treating ulcerated wounds on the legs, a patient may opt to use Unna boot bandages. Named after German dermatologist Dr. Paul Gerson Unna, this type of bandage made of cotton cloth and a paste made of zinc oxide with calamine and glycerin under certain circumstances. It’s similar to the way plaster is utilized in a hard cast but doesn’t harden. This bandage works as a barrier to keep patients from scratching ulcerated wounds and prevents infection. The boot usually extends from the toes to just below the knee, and when the zinc oxide dries an elastic band is wrapped around the boot to maintain pressure on the foot and leg. The Unna boot should be replaced every week or so until the ulcer has healed. Since the link oxide does not cake or dry out, this type of bandage and stay on longer than other methods. Most patients treated with an Unna boot are ambulatory, wheelchair or bedridden patients are treated with other methods. Some brands patients might consider are Dynarex, Dumex/Derma Sciences, Convatec, or Covidien.


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