Taping and Bandaging

Taping and bandaging are essential skills in wilderness medicine. Taping can support injured joints and soft tissues; bandaging is most often used to secure a wound dressing. Bandaging with an elastic wrap can be an alternative to taping. Over larger joints (e.g., the knee), it is often preferable.

Taping requires practice and experience, but certain simple techniques can be easily mastered. Taping is most often used for mild to moderate sprains and strains where some functional capacities (e.g., weight bearing and lifting) are maintained. Taping offers limited dynamic support but is in no way comparable to splinting, which is intended to immobilize an extremity. White athletic or “adhesive” tape used by athletic trainers in organized sports is most commonly used. Athletic tape may be applied to the skin, although adhesion may be lost if the body part is not shaved and if tape adhesive is not applied.

Some keys to successful taping include the following:

• Tape that has been exposed to the elements (cold, wetness, direct sunlight) degrades quickly. Keep medical tape inside a first aid kit to ensure viability.

• Apply tape to clean and dry skin. It may be necessary to wait until shelter is available to create an effective taping system.

• Avoid leaving any gaps in the tape (i.e., allowing any skin to be visible). These gaps lead to blisters. Avoid excessive tension on tape strips that serve to fill such gaps.

• Apply tape to follow skin contours in order to avoid wrinkles.

• Try to overlap one-half of the width of the tape with each successive strip or wrap.

Bandaging is accomplished with either elastic wraps or gauze rolls of varying widths. After a dressing is applied to a wound, appropriate bandaging allows the patient to feel confident that the dressing will remain secure during activity. Regardless of the method used, it is important to remember that taping and bandaging, especially when circumferential, should not be so tight as to limit circulation.

Skin Preparation

Skin preparation increases patient comfort as well as longevity of tape adhesion. Before tape is applied directly to skin, first gently shave to remove hair that may interfere with direct contact. Take care to avoid creating skin abrasions when shaving. These can serve as entry sites for infection. If the area cannot be shaved in a clean and deliberate manner, avoid shaving. Cover any preexisting wound with a thin layer of gauze or a small adhesive bandage before taping.

If the area is not shaved, a foam under-wrap or pre-wrap is used to cover body hair. Pre-wrap rolls are available in a 3-inch width. After application of a topical skin adhesive, prewrap is applied over the part to be taped in a simple, continuous circular wrap. Prewrap is sufficiently self-adherent and does not need to be taped.

Tape applied over bony prominences can create tension on the skin surface that causes blistering. Use heel-and-lace pads and foam pads to prevent blisters and provide additional comfort by relieving potential pressure points. Heel-and-lace pads are prefabricated pieces of white foam that are adhered together with petroleum jelly and applied to the anterior and posterior aspects of the talus before the ankle is taped. Pads of foam can be cut to size to fit over painful areas that need to be taped (e.g., for medial tibial stress syndrome) or used for support in special cases (e.g., for patellar subluxation).

Ankle taping

A: With ankle bent 90 degrees, apply anchors of 1.5-inch–wide tape at the lower leg and distal foot.

B: Apply three stirrups from a medial to a lateral direction in a slight fanlike projection.

C: Fill in any gaps with horizontal strips.

D: Begin the figure-of-eight technique. Apply tape across the front of the ankle in a left-to-right direction.

E: Continue taping under the foot to the opposite side, and cross back over the top of the foot.

F: Complete by wrapping tape around the leg, and end at the anterior aspect of the ankle.

G: Apply heel locks for both feet (omit if not familiar with this technique). Start in a lateral to medial direction, and apply tape across the front of the joint.

H: Wrap tape around the heel (the bottom margin of the tape should be above the superior edge of the calcaneus) to form the first heel lock.

I: Continue under the foot to the opposite side and cross back over the top of the foot.

J: Tape is then brought back around the superior margin of the calcaneus and down and around the heel.

K: Finish by wrapping tape around the ankle. Repeat the figure-of-eight or heel-lock technique as desired.

Knee Taping

Because the knee is a large joint, taping requires advanced expertise. Underwrap should not be used, because adequate traction to support the joint can only be achieved by taping directly to the skin. The patient's knee should be shaved 6 inches above and below the joint line. Standard athletic tape should not be used, because it cannot provide sufficient support. Three-inch–wide elastic tape provides the foundation. For injuries of the lateral aspect of the knee, mirror the process described.

Finger Taping

Injuries to fingers are common. Simple fractures and sprains can be initially treated by taping. The most common scenarios involve fingers that are hyperextended or that are “jammed.” Injuries in this scenario are often to the palmar ligaments and tendons. Patients may find it difficult to flex the finger against resistance of an examiner's finger, or may demonstrate tenderness over the palmar aspect of the finger. Swelling is almost always present, so the precise injury may be difficult to diagnose without imaging. This presentation is also seen after reduction of a dorsal dislocation of the proximal interphalangeal joint. In these cases, it is best to splint or tape the finger in slight flexion to avoid further injury to the flexor apparatus.

Fingers are buddy taped to the adjacent finger, which serves as a splint. Second and third fingers and fourth and fifth fingers are always paired. If third and fourth fingers are paired, this makes injury to the second and fifth fingers more likely with subsequent activity.

Wrist and Hand Bandaging

Wrist support can be supplied by using an elastic wrap 2 to 3 inches wide with a continuous wrapping technique. Using gauze, this same technique can secure a dressing to a wound on the palm of the hand. A hand cravat bandage can be used for wounds that continue to bleed despite manual pressure.

Wrist bandaging

A: Begin by encircling the wrist with the bandage two to three times.

B: Continue bandaging across the dorsum of the hand, through the first web space, and around the base of the proximal phalanges.

C: Continue down and across the dorsum of the hand.

D: Circle the wrist, and bring the bandage across the dorsum of the hand to form a figure-of-eight.

E: Repeat these steps, and make alternating figure-of-eight patterns on the dorsum of the hand. Secure the bandage at the wrist.

Hand Bandaging