Question:
In a standard 4-layer bandage (4LB) system, which layer exerts the maximum pressure on the leg?
In a standard 4-layer bandage (4LB) system, which layer exerts the maximum pressure on the leg?
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Remember the layers of the 4LB:
1. Wool (Padding/Absorption).
2. Crepe (Smoothing/Support).
3. Elastic (Moderate Compression).
4. Cohesive (Maximum Compression/Security).
Always rule out severe arterial disease (ABPI $< 0.8$) before applying high-compression bandages!
1. Wool (Padding/Absorption).
2. Crepe (Smoothing/Support).
3. Elastic (Moderate Compression).
4. Cohesive (Maximum Compression/Security).
Always rule out severe arterial disease (ABPI $< 0.8$) before applying high-compression bandages!
Updated On: Sep 3, 2026
- Cohesive bandage
- Elastic bandage
- Orthopaedic wool
- Cotton crepe
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The Correct Option is A
Solution and Explanation
Concept:
The clinical scenario tests the clinician's knowledge of compression therapy mechanics, specifically the components of the multi-layer bandage system used to heal venous leg ulcers.
Explanation:
• The 4-layer bandage (4LB) system is the gold standard compression therapy designed to provide sustained, graduated compression (typically 40 mmHg at the ankle, decreasing to 17 mmHg at the knee) to reverse venous hypertension.
• The system consists of four distinct, sequentially applied layers.
• Layer 1: Orthopaedic wool. This is purely for padding, protecting bony prominences, and absorbing wound exudate. It provides zero compression.
• Layer 2: Cotton crepe bandage. This layer smoothes the wool, provides a light shape to the leg, and offers minimal compression.
• Layer 3: Elastic bandage (e.g., Elset). This is the first highly active layer, applied in a figure-of-eight pattern to provide roughly half of the required compression (about 17-20 mmHg).
• Layer 4: Cohesive bandage (e.g., Coban). This is the strong, outermost layer. It adheres to itself, preventing the system from slipping, and crucially, it delivers the highest amount of elastic recoil and compressive force (an additional 20-23 mmHg).
• Therefore, the outermost cohesive layer is the primary structural component that exerts the maximum compressive pressure on the leg to achieve the target 40 mmHg gradient.
Final Answer:
The outermost cohesive bandage layer is responsible for exerting the maximum compressive pressure in a 4-layer system.
The clinical scenario tests the clinician's knowledge of compression therapy mechanics, specifically the components of the multi-layer bandage system used to heal venous leg ulcers.
Explanation:
• The 4-layer bandage (4LB) system is the gold standard compression therapy designed to provide sustained, graduated compression (typically 40 mmHg at the ankle, decreasing to 17 mmHg at the knee) to reverse venous hypertension.
• The system consists of four distinct, sequentially applied layers.
• Layer 1: Orthopaedic wool. This is purely for padding, protecting bony prominences, and absorbing wound exudate. It provides zero compression.
• Layer 2: Cotton crepe bandage. This layer smoothes the wool, provides a light shape to the leg, and offers minimal compression.
• Layer 3: Elastic bandage (e.g., Elset). This is the first highly active layer, applied in a figure-of-eight pattern to provide roughly half of the required compression (about 17-20 mmHg).
• Layer 4: Cohesive bandage (e.g., Coban). This is the strong, outermost layer. It adheres to itself, preventing the system from slipping, and crucially, it delivers the highest amount of elastic recoil and compressive force (an additional 20-23 mmHg).
• Therefore, the outermost cohesive layer is the primary structural component that exerts the maximum compressive pressure on the leg to achieve the target 40 mmHg gradient.
Final Answer:
The outermost cohesive bandage layer is responsible for exerting the maximum compressive pressure in a 4-layer system.
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