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The use of a silicone dressing sheet or strip to protect bony prominences under compression

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Rebecca Elwell - Msc Lymphoedema, Macmillan Lymphoedema Nurse Specialist

Introduction - It has long been recognised that bony prominences need protection when applying compression EWMA (2005). This has traditionally been achieved with under cast wadding or foam. This however increases bulk which leads to poor patient experience Whitaker et al (2015).

Method - An alternative protective layer in the form of a silicone sheet or strip was used on a series of patients undergoing Decongestive Lymphatic Therapy (Multi layered compression bandaging, Manual Lymphatic drainage, skincare and exercise) for lymphoedema.

The main areas requiring compression were the dorsum of the foot, the front ankle fold and behind the knee. In a smaller group the shin needed protection. The silicone sheet or strip was applied directly to the skin and inelastic bandages were applied over cotton stockinette and padding.

Results - In patients who had previously experienced redness, soreness and blistering with Multi Layered Lymphoedema bandaging the application of the silicone sheet or strip reversed these skin changes in one bandage application (24 hours) and was described as very comfortable. In patients who had not previously experienced skin redness or soreness the skin remained in good condition with no trauma.

Discussion - As bandaging for lymphoedema requires high levels of compression (EWMA, 2014) protecting the bony prominences is of paramount importance. This is also the case for compression hosiery, again these can be highly compressive garments at  Class 4 (RAL) and friction can be a problem, especially for some very active patients. The silicone sheet or strip performed well under both bandaging and compression hosiery.

Conclusion - Silicone in the form of a sheet or strip is an effective way to protect bony prominences under compression whilst maintaining low profile bandaging, reducing bulk to ensure maximum mobilisation is possible to keep patients as active as possible, in their own footwear. Although perceived as expensive, the silicone is reusable multiple times for the same patients and represents good value for money.

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