Association (medicine)

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Depiction of a bandage on an ancient Greek vase
First dressing for a small head wound (19th century painting)

The term association stands for a multitude of very different, externally applicable treatment techniques. In the literal sense, it means attaching wound dressings to the body. In the meantime, the scope has expanded considerably.

history

It will probably not be possible to determine when the first bandages were applied. As one can still see with primitive peoples today, it can be assumed that wounds were covered with natural materials or immobilized in primeval times in order to aid healing.

For a long time, wound dressings consisted primarily of textiles. Even in ancient times there was a high level of dressing technology, also with regard to hygienic procedures. Little is known in detail about the bandage techniques.

Due to a lack of knowledge, especially in microbiology, principles for associations that are sometimes perceived as adventurous have now been developed in medicine. So one was z. For example, in the middle of the 19th century in Europe, the opinion was that a soiled dressing from a wound that had healed successfully promoted healing in other patients.

With increasing knowledge of hygiene, cotton and linen were (again) the predominant dressing materials for a long time, as they could be sterilized. So-called dry wound treatment dominated . Since the beginning of the 20th century, new materials for bandages have increasingly been added. The development of permanently elastic fabrics and skin-friendly adhesives should be emphasized here.

It was not until the middle of the 20th century, when adequate moist wound treatment became possible with in-depth knowledge of the healing processes but also through the development of new materials, especially alginates and breathable films , that a fundamental reorientation took place.

function

Associations have a wide range of applications and therefore sometimes have to provide contradicting services. Of course, it is particularly important that associations should not cause any damage.

A major problem of almost all wound dressings is the threat of sticking or adhesion of the wound with dressing material and the then recurring disruption of the healing process due to dressing changes. This problem has to be solved primarily through the use of suitable materials. In addition, bandages often restrict body functions, for example when splints immobilize joints. This not only leads to a reduction in the quality of life for the duration of the treatment; it can also lead to consequential damage, which may be permanent.

Positive demands on associations can be:

material

The material must follow the function and is therefore just as diverse as the areas of application. Dressing material should in principle cause as little additional stress as possible, i.e. not cause skin irritation or pressure points and leave no residue in wounds that inhibit wound healing, e.g. B. do not fluff.

Immobilizing bandages

Solid materials are used for immobilizing bandages, such as splints made of metal, e.g. B. in the form of wire rails , plastics or earlier also made of wood. The classic immobilizing bandage is still the plaster bandage , which has recently been replaced more and more by bandages made of various water-polymerizing, fiber-reinforced plastics (e.g. cast ), which are easier to care for and lighter. Where complete immobilization is not necessary, fixed textile materials can also have a relieving effect, such as elastic bandages , zinc glue bandages or tape bandages .

Even today, padding materials are often compresses or cotton wool , but also here increasingly plastics, for example in the form of foam or gel cushions .

Compression bandages

Elastic bandages, stockings or adaptive compression bandages are usually used for compression bandages . Depending on the therapy goal, very different formats and material properties are available, e.g. For example, more elastic materials ( long-stretch bandages ) are used for depth effects and static pressure, for example with mobile patients, and less elastic materials ( short-stretch bandages ) for more superficial effects in bedridden patients. However, long-stretch bandages must be removed at night and if you take a break of more than ten minutes.

Wound dressings

Modern dressing for moist wound care

Textiles are mainly used in classic wound dressings. They consist of several layers, which may have to fulfill different tasks. In the past, the wound dressing consisted mainly of cotton compresses . Silk fabrics were also often used for burn wounds.

For secondary wound healing , moist dressings are increasingly used, especially for chronic wounds such as leg ulcers . Alginates , hydrocolloids or special foams are increasingly being used for moist wound treatment . This also solves the problem of the bandage and wound surface sticking together. As long as such supply systems are not available, or where they are not indicated, attempts are made to avoid adhesions by means of metal-coated tissue or the application of greased gauze to the wound surface.

The fixation of the wound dressing used to be done almost exclusively with (probably the first time at the end of the 15th century by the surgeon Alexander Hartmann from "franckfurtt" so called) roll bandages ( gauze bandages or linen bandages). In recent times, elastic bandages (often with an adhesive coating) or textile tubes (hose gauze, "Stülpa" ®) are increasingly used for this purpose . With the development of breathable foils, wound dressings are already fixed directly with adhesive foils, which makes it easier to observe the wound area, but can cause hypersensitivity reactions to adhesives. In the care of smaller wounds, first aid bandages and spray plasters are also used .

In first aid, bandages , triangular towels and prepared combinations of materials are also used as first aid packs .

Tools

Aids for building up a bandage can also be greased gauze , alginates , cellulose or paper and, of course, a wide variety of medicinal substances which are placed under or in the wound dressing. There are also bandage clips, safety pins or adhesive strips and adhesive plasters to secure bandage ends or bandage edges.

Tubular bandage on a finger for fastening bandages

In addition to the already mentioned function of fastening bandage material, the "tricot tubes" are made in the form of tubes with different diameters as an aid for. B. used as a "underlay" for plaster casts or to cover the skin on the amputation stump .

Special forms

Techniques of joining

Traditionally, bandages were created by wrapping. The basic form for this is the spiral thread, in which binding threads are evenly and partially overlapped. The so-called figure-of-eight tour is a modification that provides greater stability. With the same aim, the Corn Ears Association and Umschlagverband were developed. For difficult anatomical conditions, such as joints or bandages in the shoulder or hip area, elaborate wrapping schemes were developed that required a high level of expertise and practice, such as the “Desault” armpit-shoulder-elbow bandage or the “head-halter bandage”. With the advent of tubular gauze, elastic bandages and self-adhesive or adhesive bandage materials in the 1980s, winding techniques lost their importance. They are only still used for compression bandages.

Today there are a large number of industrially prefabricated systems, each of which must be correctly selected, adapted and then specifically monitored. The key concept here is the “ physiological wound environment”.

When treating deep defects, cavities sometimes have to be filled, for example in the form of tamponades (or drainage probes). In the past, cotton fabric was mostly used here, and foams or synthetic fiber cushions are also increasingly being used here.

Special preparation of the subsurface is also often necessary when applying immobilizing bandages. Edges and bones have to be padded and reinforcements have to be built into the bandage at mechanically stressed areas.

Dressing change

Dressing changes are opportunities to have a therapeutic effect on the wound, for example by applying medication or rinsing the wound. In addition, the healing can be assessed and documented by observing the wound and wound dressing. However, during a dressing change there is also the risk of the wound cooling down, the risk of disrupting the healing process, the possibility for germs and pathogens to get to the wound or even an infection . Therefore, the rules of aseptic work must be strictly observed. In modern wound care, the so-called " non-touch technology ", i.e. H. the exclusive contact of the wound area with sterile materials or sterilized instruments (not by hand) is established.

literature

  • Ursula Kowe: The history of the dressing material . med. Diss., Bonn 1958
  • Johannes Steudel : The bandage material in the history of medicine: A cultural-historical overview. Düren in the Rhineland 1964
  • Ingo Blank: wound care and dressing change. Kohlhammer, Stuttgart 2007, ISBN 3-17-016219-5
  • Eibl-Eibesfeld, Kessler: Stenger association theory. 6., revised. Edition. Urban & Schwarzenberg 1997, ISBN 3-541-02856-4
  • Thiemes care. Lim. by Liliane Juchli ; Ed. Edith Kellnhauser . 9., revised. Edition. Thieme, Stuttgart / New York 2000, ISBN 3-13-500009-5 .
  • S2 guideline : Phlebological Compression Association (PKV) , AWMF register number 037/005 ( full text ), status 06/2009

Individual evidence

  1. Wolfgang Wegner: Hartmann, Alexander. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 536 f.
  2. Volker Zimmermann: Hartmann, Alexander. In: Burghart Wachinger u. a. (Ed.): The German literature of the Middle Ages. Author Lexicon . 2nd, completely revised edition. Volume 3. De Gruyter, Berlin / New York 1981, ISBN 3-11-007264-5 , Sp. 499.