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Kim et al. Pressures secondary to circumferential digital dressings

Table 3: Statistical differences according to rolling up at Table 5: Statistical differences according to rolling up
different lengths in the child finger model (mean ± SD) of adult and child finger models (mean ± SD)
Group NR R P value Group A B P value
1C-T0-Ph 0.0 ± 0.0 210.6 ± 117.0 < 0.001 1C-T0-Ph-R 57.9 ± 7.2 210.6 ± 117.0 0.003
2C-T0-Ph 0.0 ± 0.0 323.7 ± 186.9 < 0.001 2C-T0-Ph-R 69.5 ± 12.1 323.7 ± 186.9 0.002
3C-T0-Ph 0.0 ± 0.0 904.9 ± 462.1 < 0.001 3C-T0-Ph-R 114.1 ± 34.0 904.9 ± 462.1 0.000
NR: unrolled; R: rolled up; 1C: elastic dressing was wound 1 lap around (1C~3C)-T0-Ph-R 80.5 ± 32.1 479.7 ± 420.8 < 0.001
a finger model with the same length of its circumference (7 cm); 2C: A: adult finger model; B: child finger model; R: rolled up; 1C: elastic
elastic dressing was wound 2 laps around a finger model with 2 dressing was wound 1 lap around a finger model with the same length
times the length of its circumference (14 cm); 3C: elastic dressing as its circumference (7 cm); 2C: elastic dressing was wound 2 laps
was wound 3 laps around a finger model with 3 times the length of around a finger model with 2 times the length of its circumference
its circumference (21 cm); T0: 0% tightened; Ph: Peha-haft (14 cm); 3C: elastic dressing was wound 3 laps around a finger
model with 3 times the length of its circumference (21 cm); T0: 0%
Table 4: Statistical differences according to rolling up tightened; Ph: Peha-haft
at different lengths in the adult finger of a living body
(mean ± SD) Table 6: Statistical differences according to rolling up
of the adult finger model and the live finger (mean ± SD)
Group NR R P value
1C-T0-Ph 0.0 ± 0.0 277.5 ± 227.5 0.004 Group A C P value
2C-T0-Ph 0.0 ± 0.0 636.2 ± 558.0 0.006 1C-T0-Ph-R 57.9 ± 7.2 277.5 ± 227.5 0.014
3C-T0-Ph 0.0 ± 0.0 1,005.6 ± 644.5 0.001 2C-T0-Ph-R 69.5 ± 12.1 636.2 ± 558.0 0.011
NR: unrolled; R: rolled up; 1C: elastic dressing was wound 1 lap around 3C-T0-Ph-R 114.1 ± 34.0 1,005.6 ± 644.5 0.002
a finger model with the same length as its circumference (7 cm); 2C: (1C~3C)-T0-Ph-R 80.5 ± 32.1 639.7 ± 577.1 < 0.001
elastic dressing was wound 2 laps around a finger model with 2 A: adult finger model; C: finger in living body; R: rolled up; 1C: elastic
times the length of its circumference (14 cm); 3C: elastic dressing dressing was wound 1 lap around a finger model with the same length
was wound 3 laps around a finger model with 3 times the length of as its circumference (7 cm); 2C: elastic dressing was wound 2 laps
its circumference (21 cm); T0: 0% tightened; Ph: Peha-haft around a finger model with 2 times the length of its circumference
(14 cm); 3C: elastic dressing was wound 3 laps around a finger
tightened bandages of the 2C group. In the 19.7% and model with 3 times the length of its circumference (21 cm); T0: 0%
33.5% tightened bandages of the 2C group (2C-T2, tightened; Ph: Peha-haft
2C-T3), the measured pressures of the Ph (2C-T2-Ph, finger model (1C~3C-T0-R, 80.5 ± 32.1 mmHg) were
56.2 ± 58.5 mmHg), (2C-T3-Ph, 185.3 ± 218.6 mmHg) significantly lower than those in the child finger model
were significantly lower than those for Co (2C-T2-Co,
466.0 ± 502.3 mmHg, P = 0.002), (2C-T3-Co, 757.2 ± (1C~3C-T0-R, 479.7 ± 420.8 mmHg, P < 0.001) and live
839.7 mmHg, P = 0.008). adult finger (1C~3C-T0-R, 639.7 ± 577.1 mmHg, P <
0.001). In the above situations, the same results were
Rolling up at different lengths along the child finger shown for each wrap [Tables 5 and 6].
model (NR, R in 1C-T0, 2C-T0, 3C-T0): in each wrap
using the Ph (1C-T0-Ph, 2C-T0-Ph, 3C-T0-Ph), the DISCUSSION
measured pressures of the unrolled bandage (1C-T0-
Ph-NR, 0 ± 0 mmHg), (2C-T0-Ph-NR, 0 ± 0 mmHg), As material is rolled around a digit, it becomes tighter,
(3C-T0-Ph-NR, 0 ± 0 mmHg) were significantly lower exsanguinating the fingertip and constricting the digit.
than those for the rolled up bandage (1C-T0-Ph-R, This quickly becomes uncomfortable. If this happens
210.6 ± 117.0 mmHg, P < 0.001), (2C-T0-Ph-R, 323.7 to an adult, the patient will likely cut and remove the
± 186.9 mmHg, P < 0.001), (3C-T0-Ph-R, 904.9 ± constricting device. However, children, especially
462.1 mmHg, P < 0.001) [Table 3]. those two years old and under, do not understand this
and cannot remove the dressing quickly. A similar lack
Rolling up at different lengths along the live adult finger of understanding or action also may occur in elderly
(NR, R in 1C-T0, 2C-T0, 3C-T0): in each wrap with the and mentally compromised patients. If the constriction
Ph (1C-T0-Ph, 2C-T0-Ph, 3C-T0-Ph), the measured tightens to the point that all vascular flow is impeded
pressures of the unrolled bandage (1C-T0-Ph-NR, 0 into the tip of the digit, hypoxia and eventually tissue
± 0 mmHg), (2C-T0-Ph-NR, 0 ± 0 mmHg), (3C-T0-Ph- necrosis will occur. Thus, a simple, soft tissue injury
NR, 0 ± 0 mmHg) were significantly lower than those for can become a more serious injury. Although no studies
rolled up bandage (1C-T0-Ph-R, 277.5 ± 227.5 mmHg, in the literature have reported the incidence of this
P = 0.004), (2C-T0-Ph-R, 636.2 ± 558.0 mmHg, P condition, any physician who has applied a finger
= 0.006), (3C-T0-Ph-R, 1,005.6 ± 644.5 mmHg, P = dressing knows how easily a circumferentially applied
0.001) [Table 4]. dressing, such as Co, can roll up when manipulated,
as when a child plays with a dressing. [4]
In the rolled up bandage of the untightened group
[2]
(1C~3C-T0-R), the measured pressures along the adult Lahham et al. noted that digital tourniquet methods
46 Plastic and Aesthetic Research ¦ Volume 4 ¦ March 22, 2017