Surgery Book

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Unna's Boot

Aka: Unna's Boot, Unna Boot, Unna's Paste Boot, Dome-paste bandage, Gelocast Bandage
  1. History
    1. After Paul Gerson Unna, German dermatologist 1850-1929
  2. Indications
    1. Refractory Venous Stasis Ulcer
    2. Ankle Sprain with venous insuffiency or atrophy
    3. Localized Neurodermatitis
  3. Mechanism
    1. Prevents edema development
    2. Medication impregnated dressing
      1. Zinc oxide paste
      2. Calamine lotion
      3. Glycerin
      4. Gelatin
  4. Technique
    1. Reduce local edema before boot application
      1. Patient prepares leg at home on boot application day
      2. Ulcer covered with bandage
      3. Ace bandage applied firmly from foot to knee
    2. Leg prepared for Unna Boot
      1. Ace bandaged removed at clinic
      2. Skin cleansed and ulcer debrided as needed
      3. Apply Skin Lubricant to normal skin of leg
      4. If chronic inflammation present around ulcer:
        1. Apply medium potency Topical Corticosteroid
    3. Apply Unna's Boot per package instructions
      1. Layered application (avoid creases or folds)
        1. Starts behind first Metatarsal
        2. Ends below tibial tubercle of knee
        3. Overlap each turn half of width of previous turn
      2. Cast dries within 1 hour (firmness of cardboard)
        1. Consider covering cast with ace bandage when dry
    4. Follow-up
      1. Unna's Boot changed every 7-10 days
      2. Remove with bandage scissors
      3. Change bandage if drainage penetrates cast
  5. Advantages
    1. Comfortable and soothes skin
    2. Protects skin from scratching
  6. Disadvantages
    1. Sticky sensation in warm weather
    2. Contact Dermatitis may occur in some patients
    3. Less effective for non-ambulatory patients
    4. Pressure decreases with reduced edema (reapply)
  7. References
    1. Habif (1996) Clinical Dermatology, Mosby, p. 79
    2. Rosen (1998) Emergency Medicine, Mosby, p. 618
    3. Wooten (2001) Clin Fam Pract 3(3):599-626 [PubMed]

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