Safe and Effective Use of Coban for Post-Burn Management of Hand Edema and Scar Control
- Shiou-Han Yang
- 2 days ago
- 3 min read
Shiou-Han Yang, Senior Occupational Therapist
Taipei Rehabilitation Center, Sunshine Social Welfare Foundation
Compression wrapping is a foundational technique in burn rehabilitation, particularly for managing edema and guiding scar maturation in the hands. When used thoughtfully, Coban — a self-adhering elastic wrap — can help reduce swelling, promote functional hand use, and support scar remodeling. However, its effectiveness depends on careful clinical application.
In this post, we'll highlight key considerations, contraindications, and monitoring strategies when using Coban for post-burn management of hand edema and scar control. If you're looking for a full step-by-step demonstration, be sure to watch the video embedded below.
Why Use Coban for Post-Burn Management of Hand Edema and Scar Control?
Coban provides light, consistent pressure that helps:
Move interstitial fluid away from the fingers (edema control)
Support proper scar orientation and remodeling
Maintain hand function by reducing bulk from swelling
It is particularly useful during the sub-acute phase and beyond, especially when open wounds are minimal or fully closed but the scar surface remains fragile and unstable. At this stage, the skin may still blister or break easily with friction or minor pressure. Coban does not create friction against the skin as long as it is applied without excessive tension, making it suitable for both unstable and stable scars. It also serves as an excellent temporary pressure therapy tool — useful for reducing edema before taking measurements for pressure garment gloves, or when patients are awaiting the arrival of their custom garments.
For a deeper dive into the causes and types of hand edema after burn injury, see our post: It’s not just swelling… Why you should pay close attention to edema of the hand
Key Considerations Before Applying Coban
While Coban is easy to use, its clinical success hinges on proper technique and good judgment. Here are several considerations to guide your application:
Wrap Direction Matters: Always wrap from distal to proximal to encourage venous return and lymphatic drainage. Starting from the fingertips and moving toward the wrist is essential for edema control.
Adjust for Hand Deformities: For patients with a cupping hand posture due to palmar scarring, start wrapping from the palm side. This encourages extension and helps "open up" the hand. Starting from the dorsum in these cases may reinforce the existing contracture.
Use the Right Width of Coban tape: Use a 1-inch Coban for fingers and a 2-inch Coban for the palm and wrist. Adjust length and layering based on hand size and severity of swelling.
Protect Vulnerable Skin: If the skin in finger web spaces appears dry, thin, or at risk of cracking, apply a layer of gauze before adding compression strips. This prevents shearing and skin breakdown during use.
For more on assessing scar readiness and maintaining skin integrity during therapy, see our related post: Pressure therapy for burn scars: What are the considerations for scar stability? Balancing scar protection and scar control
Contraindications: When Not to Use Coban
Coban should NOT be applied if any of the following are present:
Skin grafts or flaps within the last two weeks
Compartment syndrome or high-risk symptoms
Arterial insufficiency, such as poor capillary refill or cold digits
Exposed tendons, bone, or deep tissue structures
If you're uncertain, pause and consult with the medical team before proceeding.
Monitoring and Safety: What to Look For
After applying Coban, be sure to monitor the patient closely:
Color: Fingertips should remain pink or consistent with baseline tone.
Capillary Refill: Should be under 2 seconds.
Temperature: Skin should remain warm, not cool.
Sensory Feedback: Ask the patient about tingling, numbness, or discomfort.
Recheck these signs again 10 to 30 minutes after wrapping, as issues may emerge over time with changes in circulation or swelling. If Coban leaves deep indentations or causes the fingertips to bulge ("mushrooming"), remove and rewrap with less tension.
Aftercare and Reuse
If the Coban remains clean and intact, it can often be reused for the same patient. However, avoid reuse if Coban:
Has come into contact with wounds or bodily fluids
Has lost elasticity
Was coated with lotion to reduce adhesion
Always remove Coban gently and in layers, especially near web spaces.
Watch the Full Video Demonstration
Want to see exactly how Coban is applied to each finger and the palm, and how to safely add pressure to the web spaces?
Watch our step-by-step instructional video below, designed for burn therapists, occupational therapists, and physical therapists working in hand rehabilitation:
Final Thoughts
Coban wrapping is a versatile and effective tool for hand edema and scar control when used with clinical insight and attention to safety. By considering deformities, protecting the skin, and watching for contraindications, therapists can ensure that compression therapy supports healing without introducing harm.
Whether you're a seasoned therapist or a clinician in training, we hope this guide provides useful reminders for safer Coban application.
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