Bolster dressings

Bolster dressings are used to prevent excessive soft tissue movement around skeletal screws, pins or wires. They are generally used on femoral screw sites, or on half-pin sites on Ilizarov or Taylor spatial frames. Reducing soft tissue movement with the application of a bolster dressing can lessen patient discomfort and prevent pin site infection. There is little evidence available to support the use of any one particular type of bolster dressing. Each child or young person and fixator is different, therefore the types of bolster dressings used can vary.

Points to remember:

• A ‘bolster dressing’ is a pack of firm dressing material between the child’s skin and fixator.
• The bolster dressing should be removed before daily pin site cleaning or swimming, and reapplied after daily pin site cleaning.
• No one method or type of bolster dressing is absolute.
• The main principle of bolster dressings is to prevent the constant movement of soft tissues around a skeletal screw, pin or wire.

Examples of bolster dressings

Keyhole bolster dressing

Step A

• On a small square of gauze, make a diagonal cut from one corner to the centre

Step B

• Apply the gauze square around the pin/wire and secure by applying tape to gauze, not skin

Ribbon gauze bolster dressing

Step C

• Apply a small key hole gauze pad to the pin site (Step C)

Step D

• Unfold a large gauze swab and roll into a ‘sausage shape’. Wrap the gauze ‘sausage’ around the pin site, applying pressure to ensure a firm dressing (Step D)
• Secure with tape (on the gauze not the skin)

Gauze figure of 8 bolster dressing

Step E

• Apply a small key hole gauze dressing around each pin/screw (Step E) and secure with tape as in Step B

Step F

• Unfold a large gauze swab and roll into a ‘sausage shape’. Wrap the gauze ‘sausage’ around two pins/screws using a figure of ‘8’, applying pressure to ensure a firm dressing (Step F)
• You may need to use more than one gauze ‘sausage’. Secure with tape (on the gauze not the skin)