Letter: A Reliable Method of Applying a Circumferential Dressing

Dear Sir The correct application of a dressing to a wound postoperatively is almost as important as the procedure itself. This is especially true in the field of plastic surgery where flaps and skin grafts are involved in wound repair. Wound dressing is important as it acts as a barrier to protect the wound from infection and physical damage. However, when applied incorrectly with excessive pressure, wound healing can be impaired. In cases of flap resurfacing of a wound, the applied dressing must be of adequate pressure yet not excessive enough to impair the blood flow and hence flap viability. Securing the dressing to a wound can potentially cause excessive pressure to the wound. Amongst all the various methods of securing a dressing, wrapping a bandage around a limb circumferentially has the highest risk of applying excessive pressure on the wound. This excessive pressure can lead to either venous congestion or occlusion of the arterial supply to the underlying flap, which can result in partial or complete flap loss (1,2). To our knowledge, no standardised technique has been described to dress a flap reconstruction wound circumferentially around the limb with an adequate amount of pressure. We propose a simple and adequate method of circumferential dressing on a flap reconstruction on a limb. We place an intact roll of a regular 6-in. crepe bandage on top of the wound covered with loose gauze before applying the circumferential bandage (Figure 1). Before securing the final wrap, we remove the roll of bandage. In this way, by creating an extra space between the flap wound and the bandage, we create enough slack so that the circumferential dressing does not occlude the flap or its pedicle, yet secure enough to protect the flap. Interposing of a roll of crepe bandage while applying a circumferential bandage. This technique hence uses an easily available material and is a simple and a reliable way of ensuring that the same amount of circumferential pressure is correctly applied to all limb wound reconstruction with flaps. This ensures the adequate circulation and safety to the underlying flap. Respectfully submitted,Syed Abuzar Mashhadi 1 , MBBS, FRCS-ed, FRCS-Plast Charles Yuen Yung Loh 2 , MBBS(UCL) This institution work is attributed to Great Ormond Street Hospital, London. No financial support or benefits have been received by me or any coauthor, by any member of my (our) immediate family or any individual or entity with whom or with which I (we) have a relationship from any commercial source which is related directly or indirectly to the scientific work which is reported on in the article except as described below. I (we) understand an example of such a financial interest would be a consulting relationship or stock interest in any business entity which is included in the subject matter of the manuscript or which sells a product relating to the subject matter of the manuscript.

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