SOFT-TISSUE INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 168

Inner Layer
The inner layer of a bandage should be material, such as petroleum jelly-impregnated
gauze, or a plastic such as Telfa® that does not stick to the wound and allows the bandage
to be changed relatively painlessly without aggravating the injury. Obviously, this material
must be sterile.
Dressings
The middle portion of a bandage is referred to as a dressing and has five different func-
tions:
Prevent contamination to prevent infection or limit the infection to organisms already
present
Absorb wound drainage, which must not be allowed to contaminate clothing or other
wounds
Keep the skin adjacent to the wound dry to prevent maceration and infection
Apply pressure on the underlying wound to aid in the control of bleeding or swelling
Protect the wound from further trauma To perform these functions, dressings must be
sterile and bulky. Although special dressing materials are available, simple gauze pads
that have been opened and crumpled to increase their bulk work almost as well and are
easier to transport into wilderness areas.
Dressings that have been contaminated by purulent drainage should be handled with
gloved fingers or with forceps or similar instruments that can be sterilized. Such dressings
should never be touched with bare fingers and must be disposed of by burning or in some
other manner that does not contaminate the environment. If more than one wound or more
than one injured person must be cared for, attention to the infected wounds should be put
off until last, and attendants must scrub their hands thoroughly after dressing each wound
to prevent the spread of infection.
Outer Wrapping
The outer portion of the bandage also has more than one function:
Hold the dressings securely in place
Keep the dressings from being wet by water or perspiration, which would inevitably
carry along bacteria
Apply pressure to help control bleeding and swelling
Splint and immobilize portions of the body such as the hand Materials that have some
elasticity are easier to use and stay in place better. Such materials also compress the
wound slightly, but an elastic bandage is more satisfactory if significant compression
is needed. If the wound must be kept dry, it should be covered with waterproof tape,
plastic,orsomeotherwaterproofmaterial.However,moistureaccumulatesbeneathwa-
terprooftapeandliftsitfromtheskinsurface.Ifprotectionfromoutsidemoistureisnot