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Kim et al. Pressures secondary to circumferential digital dressings

have complications associated with their use. Necrosis This study was performed to prevent an over-tightening
of a digit due to a forgotten tourniquet is an uncommon of bandages in fingers and to make the reader aware
but catastrophic complication. [7-11] Most complications of the necessity to anchor the bandage above the
occur with use of the least conspicuous dressings. [12-16] wrist. In conclusion, when applying pressure dressings
While digital necrosis secondary to a forgotten to fingers, great caution is needed to prevent rolling-up
tourniquet is the most severe complication related to which can create a tourniquet effect.
digital tourniquet use, most complications are related
to excessive tourniquet pressure. Authors’ contributions
Concept design: K. Hwang
Co (3 M Co, St. Paul, MN) is a self-adherent bandage Literature search: K. Hwang
made from a porous, non-woven polyester material, with Measurement of the pressure: H.J. Kim
strands of urethane coated with a cohesive substance. Manuscript’s preparation: H.J. Kim, K. Hwang
Co sticks only to itself and not to the skin, and provides Manuscript’s review: K. Hwang
sustained compression. [17] In soft tissue injuries, it is This paper is made from the a thesis entitled “The
recommended that 30 cm of the Co be unwound and Measurement of the Pressures Applied by Self-
allowed to relax because if applied directly from the roll, adherent Bandages to Prevent the Ischemic Damage
the tension will be too great. Mendlowitz [18] reported of the Fingers” by Han Joon Kim, A THESIS Submitted
the mean digital arterial systolic blood pressure in to the faculty of INHA UNIVERSITY in partial fulfillment
adults to be 100 mmHg, with a pressure range of 84 of the requirements for the degree of MASTER OF
to 120 mmHg. Based on their experience using digital SCIENCE, Aug, 2014.
tourniquets on patients in a clinical setting, Shaw et al. [19]
reported pressures of 150 mmHg to be “very adequate” Financial support and sponsorship
to maintain hemostasis. This study was funded by a grant from National
Research Foundation of Korea (NRF-2017-005787).
Tuncali et al. [20] reported a method for estimation of
the arterial occlusion pressure; according to these Conflicts of interest
principles the pressure necessary to prevent digital There are no conflicts of interest.
blood flow ranges from 110 to 140 mmHg. In this study,
the average pressures in the rolled and untightened Patient consent
bandage group along the live finger were significantly
higher than those for the adult finger model. Therefore, Not applicable.
dressing materials are not intended to be rolled up on Ethics approval
the finger in the clinical setting. Additionally, measured
pressures in the child finger model (479.7 ± 420.8 mmHg, All the procedures followed were in accordance with
P < 0.001) were significantly higher than those for the the ethical standards of the responsible committee on
adult finger model (80.5 ± 32.1 mmHg). These results human experimentation (institutional or regional) and
support the need for great caution when using rolled with the Helsinki Declaration when reporting studies on
bandages in children. The pressures with the use of Co human beings.
were relatively higher than those for rolled Ph, which
is thought to be due to the thickness of the dressing. REFERENCES
The thickness of Co (2 mm) is thicker than that of Ph 1. Conn JM, Annest JL, Ryan GW, Budnitz DS. Non-work-related
(1 mm) when unrolled, and therefore it becomes much finger amputations in the United States, 2001-2002. Ann Emerg Med
thicker when rolled. Therefore, great caution is needed 2005;45:630-5.
to prevent rolling of Co dressings. 2. Lahham S, Tu K, Ni M, Tran V, Lotfipour S, Anderson CL, Fox
JC. Comparison of pressures applied by digital tourniquets in the
In the current study, pressures were measured on a emergency department. West J Emerg Med 2011;12:242-9.
clay model as well as human model. In the human 3. Spruiell MD, Messina MJ, Mitchell JJ, Scott FA. A deadly digital
dressing: a case of surgical decompression for finger ischemia due to
model, limb elevation is an important method used circumferential finger dressing. J Emerg Med 2014;46:655-8.
for the prevention of post-dressing limb edema. Limb 4. Hart RG, Wolff TW, O’Neill WL Jr. Preventing tourniquet effect when
elevation plays a role in the reduction of finger swelling dressing finger wounds in children. Am J Emerg Med 2004;22:594-5.
and improving circulation. The same cannot be done in 5. Rozmaryn LM. Closed injuries: bone, ligament, and tendon. In:
the clay model. Because all data was obtained based Rozmaryn LM, editor. Fingertip Injuries. Cham: Springer Int Pub;
on the clay model instead of live fingers, it cannot 6. 2015. p. 11-55.
Sullivan W. Finger gangrene case review. Available from:
be claimed that the data mimics the clinical situation https://www.acep.org/Physician-Resources/Practice-Resources/
perfectly. This is a limitation of this study. Professionalism/Ethics/Finger-Gangrene-Case-Review/. [Last accessed
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