Table 7 Summary of post-operative dressings, wrapping and orthoses/splints
From: Hand surgery and hand therapy clinical practice guideline for epidermolysis bullosa
Options | Material examples | Indications or function | Contraindications/comments | Wear time |
|---|---|---|---|---|
Dressings: non-adherent gauze over wounds, webspaces, and fingers, in a “boxers wrap” fashion | Non adherent gauze product such as Vaseline® Petrolatum Gauze, Hollister Restore, ® Adaptic® (Systagenix), Covidien Curity® oil emulsion strips, Covidien Xeroform petrolatum gauze dressing® OR Soft silicone/foam product, such as Mepilex Lite, ® Mepitel ® or Mepilex Transfer®® (Molnlycke) Another option is to make a mixture of 50% Aquaphor® and 50% Bactroban® and spread a thin layer of this on the gauze dressings before application | Protect and promote skin healing Maintain webspaces | Soiled dressings may need to be removed with a wound irrigation solution Hand should be air dryed before applying dressings Some petroleum gauze dressing products may dry out Eventually gauze roll wrapping and/or a putty elastomer orthosis can be sufficient to maintain webspaces | Full time until skin is healed, around post op week 3–4, then just through webspaces and over isolated wounds as indicated by healing progression |
Wrapping the hand, web spaces, digits | Flexicon® 1-inch gauze Tubifast® roll gauze Elastomull® by Essity/BSN | Protection Barrier between orthosis and skin Hold dressings in place | Wrap over dressings. Avoid wrapping too tight. Must be secured by stockinette or paper tape (not taped to skin) | Full time until skin is healed, around post op week 3–4, then at night at a minimum |
Resting hand or forearm-based orthoses/splints made from lightweight thermoplastic | Rolyan Tailorsplint®® NorthCoast Medical Preferred® Orficast® thermoplastic tape (by Orfit) Orficast More® (Orfit) Orfit® Perforated (Orfit) Straps should be soft such as Alpha Strap® Loop (North Coast Medical) or Velfoam® May consider lining the orthosis with Mepilex Transfer® by Molnlycke | Support hand, digit and wrist healing and for proper positioning | Individual must be able and willing to tolerate Strongly recommended The patient may be able to scratch other body areas so edges should be soft or covered Clean with soap and water or vinegar and water | Full time through weeks 4–8, then long term use at night Monitor for refitting needs Will need to be refitted as dressing bulk decreases |
Resting hand or forearm-based orthoses/splints made from casting material | Plaster cast rolls or sheets Synthetic cast tape such as DeltaCast® Conformable by Essity/BSN (the therapist must be experienced with using these materials and functional casting technique) | Support hand, digit and wrist healing and for proper positioning | Cannot be refitted Padding can be built in May be difficult to clean Edges must be lined | Full time through weeks 4–8 |
Putty orthoses or putty inserts/liner in orthoses | Otoform Kc® by Dreve Rolyan 50/50® Soft Putty Elastomer™ by North Coast Medical | Maintain finger extension and web space depth | Material can be heavy – use only as much as needed | Same as orthosis/splint use |
Gloves | Interim® gloves (Jobskin Ltd, Nottingham, UK) Lycra® gloves Tubifast® gloves Skinnies web ™ gloves | Protect the hands and keep the webspaces formed Custom fit ensures that they conform to the web spaces They can be cleaned | Consider skin fragility and shear from gloves Grafts should be well healed Skin should be closed Glove use tends to be based on patient/family preference | The gloves can be worn 3 weeks after splinting is finished Gloves need to be replaced if the position of the digits or web spaces changes |