Preventing tourniquet effect when dressing finger wounds in children

Hand and finger injuries are common injuries in children seen in emergency departments. Many of these are soft tissue injuries, which are often caused by household items, such as doors and exercise equipment. Once these injuries are repaired, usually they are covered with a simple dressing using a material such as Coban (3M, Minneapolis, MN). This dressing often is applied by winding it circumferentially around the digit. However, with very little manipulation, this dressing can be lifted and rolled up the digit in a distal direction, creating a tourniquet effect, which can cause hypoxia and tissue necrosis. To prevent the tourniquet effect, the dressing must include the hand and wrist.