Complex bandaging….. For difficult areas too!

One of the problems with complex bandaging is that some areas that swell are difficult to bandage and so when a friend sent me information about Coban 2 bandages I was very interested to see the various ways of treating different areas.. This is a link to the 3M page which has a variety of videos for using Coban 2 bandages. You will note there are ones for the hip and tummy areas also round the breast and chest.

http://www.3m.com/intl/ca/english/market/health/Coban/videos.html

Foam or comfort layer

Foam or comfort layer

Showing the two sides of the foam layer

Showing the two sides of the foam layer

image

Compression layer bandage

The Coban two layer system includes two bandages, which is a lot less than the usual complex bandaging where the limb ends up looking very “padded” with many layers. There is one layer of foam or the “comfort” layer and then another layer that gives the compression. The other thing that makes this different from the usual complex bandaging is that the bandages stick to themselves… Not to you or your clothes but to themselves. This stops some of the slippage and makes it possible to bandage around the more difficult areas..

The friend who sent me this information has primary lymphedema and was introduced to this system of wrapping by her therapist and is trying it out for the first time. She was surprised that she could still get a running shoe on and that it was far less bulky than usual wrapping. So far she is happy with the results.. Her leg is looking very good but I know she works very hard to keep it that way, swimming, exercise and regular MLD and treatment.

Lower leg bandaged with Coban 2 layer lite with a sock over!

Lower leg bandaged with Coban 2 layer lite with a sock over!

As is everything to do with Lymphedema these bandages are not cheap but you can keep them on for a few days but must keep them dry. (I for see shower difficulties) They are also designed for one-off use… It maybe something you can speak to your therapist about, as another idea for treatment, but it may not be suitable for everyone. There may also be other brands available too and at different prices!!!

Following are some opinions on Coban 2 from therapists who use it… I asked the question on Linkedin groups to get an idea of its use.. It will not replace Complex Bandaging but it gives another option in treatment… It will suit some and not others.. I have removed names and business names from these comments but they are all qualified therapists working with Lymphedema.. ……

“Coban 2 is an ideal bandaging system especially for active people as it is easier to wear shoes & maintain a ‘normal’ lifestyle. Complex bandaging is bulky.”

“I have used coban 2 within our clinic with success. Both the patients and the therapists find it easy to use and have had success with it.”

“I use it all the time. It is fabulous, way better than the regular bandages. As a therapist I only rebadge twice a week so less contact time for patients and I. Much more comfortable for patients and I have had amazing results!”

“I was introduced to coban in 2009 and it changed my patients lives and mine as well. I was previously using only traditional bandaging which was challenging for my patients. Coban 2 provided my patients with greater adherence, improved function and mobility and they could wear normal footwear. Another plus is the comfort layer mechanically grips the skin resulting in less slippage. Wait times were decreased and less clinic visits are required for patients. I have use it for upper & lower extremity, fingers, toes, breast/chest wall & scrotal edema all with fantastic results.”

“I use the coband in a 3 layer pack (with an impregnated Zinc bandage) especially for my LE patients who are struggling with venous ulcers or broken skin. This is left on for 7days”

“And is there a difference between Coban 2 and Coflex TLC (two layer system)? Does it have the same results?”

“3M launched the Coban 2 Layer Compression System in 2006. It is designed for patients with ABPI’s of 0.8 and higher. Patients and clinicians alike were very excited with the new technology. The Coban 2 Lite was launched in 2010 as per the request of clinicians for patients with ABPI’s of 0.5-0.8, those less tolerant of high compression, new to compression bandaging, frail or less mobile. The comfort layer is a polyurethane foam with Coban backing. It is not designed to go on an open wound. An appropriate dressing is required to cover the wound. The compression layer is designed to be applied at full stretch to ensure consistency in the application process, optimizing patient outcomes. The two layers become like a soft cast as the they cohere together, resulting in less slippage for the patient. We have quite a bit of supporting evidence for the efficacy of these products.”

“Is the Coban 2 a reusable product? We’ve looked at adding it to our line but some of the therapists I spoke with were concerned with the cost when compared to washable, traditional short stretch bandages.”

“Coban 2 is a single use product – it can be applied twice a week versus daily bandaging for CDT – so saves on labour costs and patient time, but obviously more cost on product. Sounds like the way of the future but I hear that some patients cannot tolerate Coban2, so traditional bandaging will stay around.”

“How many applications of Coban 2 are typical before the patient leaves clinic care and starts self care? Is the patient responsible for paying for the Coban 2 applied at home?”

“If the client is wearing Coban for 3-7 days, how to they bathe, and what about the skin under the bandaging – does it get funky under there like it would in a cast?
Regarding fewer clinic visits, if the patient is taught how to apply the traditional bandaging, fewer visits can be achieved (as I’m sure most of you do anyway)
I do like the idea of less bulk and being able to don shoes. How are toes and fingers wrapped, and what about large thighs – is there a way Coban can stay up on conical limbs?”

“I was trained by 3M to teach other therapists to use Coban2 (Martina Reddick, RN, was instrumental in getting this product off the ground), and have been using it since before its launch almost three years ago at the International Lymphedema Conference that was held in Toronto. My clients love the bandaging system, as it is very thin and clothes and shoes are no longer an issue. Those who have used both systems will not go back to traditional short-stretch bandages. They wear the bandages for 3-4 days at a time, and, yes, in summer, just like a cast, it can be a bit itchy, but we use cornstarch, etc., to prevent that as much as possible. I have had wonderful results with it. The only problems I have had with it, are occasionally an edge is causing discomfort and the client ignores it, then it cuts into the skin. You have to be diligent about not having the edges roll and having your client TELL you when it is uncomfortable. It is cut and paste, so they can take scissors and cut the edge, if need be. With experience, that no longer seems to be an issue for me. The other problem is that, though the Coban2 has no adhesive (it does stick to itself so no need for tape), those who are allergic to adhesives are sensitive to this product. We have found ways to protect the skin and still use the product, though. The product works a little faster than traditional bandaging, and clients are being measured, generally, by 2 weeks of intensive treatment. Large limbs are not a problem, as this is a product that you can cut and paste, and you don’t need to worry about direction. You can go all over the place with it, which means you can be pretty creative with oddly shaped limbs. You can also use it for more than just limbs, such as buttocks, trunk, breast, chest. Fingers and toes are wrapped with a layer of just the coban2 lite 1 inch (which our clinic was doing already instead of layers of gauze). If it sounds like I am a fan, I AM!”

“Costs for the Coban2 bandages will vary. In our private clinic, clients pay for it. If they get it done at the hospital, the government pays. Our local CCAC (Community Care Access Centre) will provide them for free. I’ve convinced some of the insurance companies to cover it as compression that is part of the massage therapy treatment. It will depend on which country you live in, and what your health care coverage is.”

“I have used it on occasion for people that cant tolerate bandages but it really doesnt have enough compression in my opinion and in the states its expensive.”

“Yes I use it a lot. Its not difficult to learn to do compared to any other system – I went on a two day course here in the UK. You can still get good results with grossly distorted legs. The main benefits are that you can leave it on for three days, which makes it comparable cost-wise to things like Actico where you would leave for two days. The significant difference is patient compliance, because they can get their normal clothes and shoes on. I tell people to walk around as much as they can, and using Coban means they have no excuse not to due to not having shoes they can fit into. Its well tolerated by mostly everyone. When bandaging bilaterally, you need to be careful as the two legs can stick together overnight if ladies wear nightdresses, but this is easily solved with baby powder or cornflour. I like it, but I do tailor my bandaging and compression garments to each patient as I see them as individuals and lymphoedema as a very individual condition too.”

“I will be taking my Vodder recertification course in May and I will ask about that method. I’ll share any feedback I get.”

“I think 5 day a week therapy with MLD and bandaging designed with 1/2″ foam is much more effective and works quicker in the end. Changing the bandages daily reforms them to the size of their leg. The MLD is very stimulating to the system and is needed regularly. The Coban system works well in cases of CVI with legs still shaped likes cones. With the shape changes that often come with Lymphedema, the thin Coban does not provide enough pressure and shape to the bandage system. If you are really limited to how often you can see them, it is a solution. I just prefer to provide a better quality of care when possible.”

“You might find it useful to talk to Denise Hardy at Kendal Lymphology as she is a trainer in the Coban method and involved in the research too. Personally, I think this method is the future.”

“I agree with Linda. I just took my Vodder recertification 2 weeks ago and we discussed this with Robert. In the reduction phase when the client should be getting daily treatment normal short stretch bandaging should be used. You can bandage with long stretch on the foot to enable the client to wear regular shoes. However if you are not seeing the client daily Coban would be a good alternative.”

“I used the Coban 2 working in an OP Wound Clinic. It was a cost efficient solution for patients that could not come in daily or did not have too excessive drainage. If they were in an infectious stage or a scheduling spot not available in a lymphedema clinic, then this was a good solution. Foams and alginates were easily added underneath. Suspension and adherence to the compression (i.e. not removing the bandage) were good as well. I did not use the system as packaged for Elephantiasis patients.”

“For bathing with Coban 2 I recommend a cast cover. I have treated many, many people with Coban 2 and none developed “funky” skin or any type of skin problem. In my experience with teaching self bandaging very few patients choose that option, more are opting for night time compression devices that are less time consuming to don. With coban 2 there is less slippage compared to traditional bandaging. Also the option for a hip spica if slippage becomes a problem. This option works very well!”

Thank you for these responses … This allows patients to make an informed opinion on this treatment..

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23 thoughts on “Complex bandaging….. For difficult areas too!

  1. Helen I tried this – being the person who wants to try everything! It didn’t work at all for me. I got progressively worse with this bandaging. 😐 Might work for others, but didn’t work for me. You leave the bandage in place for a week I think and it just didn’t have the strength to hold my lymphedema.

    • Good to hear how you went with it.. Did normal bandaging help or was that a problem too?? I get the impression it maybe works best on those whose LE is milder.. The lady who sent me the details found that at night it felt too tight and had to try and peel it off!! Then put it back the next day!! .. I was interested in the video for bandaging hips, bottoms etc which can be impossible.. I will be interested to hear others views if they have tried it.. .. Thanks 😃

  2. Although i have read testimonies about severe le treatment with this coban it might be true that it could be more suitable for less severe le. The thing what is tricky is the pressure to apply it : if it is too strong it will cause uncomfy feeling at night that you want to pull it off. If it is not tight enough it is more comfy but less effective. and since it is for one week it is absolutely necesary that the pressure is more down then up, otherwise it might worsen (but this is in all cases of multi layer bandaging). This one advantage is that it is very thin and like Helen puts it, it sticks so unlike other bandaging which gives a gap around ankle area,… in this case it is adaptable and sticky so gives pressure on every spot …so very good for difficult areas i am sure. in these areas all bandaging slips of when you move…

  3. I am wondering if the toes and thighs swell as those areas are not bandaged. I currently wear a velcro appliance at night (which doesn’t really provide even compression) and a thigh high compression stocking during the day but would like to try this for a week. Is there a gradual permanent reduction or only temporary?

  4. The toes are also included with small bandages. The thighs can be included too, if you ask this. Coban is used for treatment reduction, you keep this on for some days or one week. Then you can have the treatment again, and if necessary one more time to reduce it gradually. Or after the first treatment you can go to get measurement for new stocking / garment. Then with new stocking you can maintain the reduction. But as always, even with stockings, after a while it starts to get more fluid accumulation … so once and a while it is good to have some kind of intense multi layer treatment done…. It takes a while to find out what reacts good to a person and what doesn’t … It seems to be very personal.

  5. I think the important point here is that the coban needs to be applied professionally if it is to be on for a week and to have any benefit… As Kahrima says … Too tight and you have a problem and to loose it will not work… It can be used for the whole leg, toes as well …. Like any treatment it suits some oeople and not others so it is important to find what works best for you… If anyone else has used this I would like to hear your imput… Did it help?? Was it comfortable?? … What were the results?? Thanks Helen

  6. Hey Helen, my Vodder lecturer answered a question on Coban recenlty via email and she has some reservations – good for some, not for others. Her concern is for the integrity of the skin as the Coban bandages do not breathe as well as the three layer system and it isn’t possible to check the skin while they are on. It definitely still needs to be applied by an expert with emphasis on gradient. And it can be difficult to remove the bandages. She sometimes uses it after a few weeks of three layer bandaging while waiting for compression garments to arrive. But I guess like with most things, worth a try to see if it works for the individual.

    • There are always pros and cons for all treatment but it gives another option for people. I remember being bandaged when i was first diagnosed.. It was the full leg then up and around my tummy too… which was very difficult to secure!! Most certainly needs to be applied by a professional.. I also wondered about the limb reducing while wearing it … Would it then become loose … Normal bandages are re applied each day so there is good compression…

  7. I think I have read that for severe cases you wear it maximum 4 days… for less severe you can keep it on one week. I think that has to do with less swelling and the bandages gets loose, so better to change it after 3 days with severe swelling…

    • I had some very positive feed back on LinkedIn when i asked therapists if they have used it … But they all seem to re bandage at about three days… Patients were more compliant as could wear normal clothes and shoes and able to be more active.. They also had good results… Will add some of these comments…

  8. i must say i was happy with the result. i lost about 2 cm on 3 days which brought it almost back to normal. the strange thing was that at night at almost every same hour (3 o clock) it started to hurt again wanting me to take it of…but after 30 ‘ it started to go better.
    i have noticed this before at night with other wrapping. .do you think the lymfactic system wakes up at 3 so therefor i get more pressure? so weird😉

    • I have no idea why that happens… Just a change of pressure i suppose?? That is good to get that reduction.. I put a question on Linkedin to get views from therapist.. As always mixed views but most happy with it.. Thought it was good as easier for clients to manage and did not have to be re done every day.. A couple prefered the bandaging but they were both Vodder trained.. Most thought not suitable for larger limbs.. Certainly quite positive feed back..especially in using for more active clients …

  9. I have added some comments from LinkedIn to the original post.. As I say pros and cons… Suitable in some situations and not in others but certainly gives an interesting option to the basic complex bandaging…

  10. thanks for the reviews! they are quite positive! indeed for active people really a reason to try it. i was even wearing heels in the weekend…i could never do that with other compression. my therapist is Vodder trained too but she goes to session to look for new stuff, which i really appreciate! it takes time to know what suits you , it can be very expensive all these things…but now i know i will try this twice a year to help my leg…

  11. Thank you for this information. I have not heard of this before. I will certainly talk to my PT about it. It’s worth a try!

    • I think it is about finding a therapist who is experienced in using it. Certainly less bulky than conventional bandages and results sound quite good… If you use it let us know the results… Thanks Helen

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