Montgomery Straps Application: Lace Ties, Skin Barriers & Dressing Changes
After large abdominal or high-output wounds, nurses change dressings often—but daily tape stripping can destroy periwound skin. This guide covers how to perform Montgomery straps application: barrier placement, parallel strap alignment, shoelace tie tension, tie-only changes, and when hot skin or fever means infection—not “tighter laces.”
Contents
Quick facts
Key takeaway
Montgomery straps protect the dressing—not the nurse’s habit of pulling tape. Place barriers on intact skin, lace ties until the pad is stable, and stop when skin creases or the patient cannot breathe comfortably. On later changes, replace ties and inner layers while straps stay put; escalating erythema needs clinician review, not tighter laces.
Quick procedure summary
| Item | Detail |
|---|---|
| Procedure name | Montgomery straps application |
| Also known as | Montgomery ties; wound tape system; repeated dressing change straps |
| Category | Wound care — dressing securement |
| Clinical purpose | Anchor dressings over large or frequently changed wounds while limiting repeated adhesive removal from fragile periwound skin |
| Who performs | Registered nurses and wound-care practitioners per competency; some steps may be delegated to trained assistive personnel under supervision per local policy |
| Estimated time | About 20–35 minutes for first application; subsequent dressing changes are often shorter when straps remain in place |
| Clinical settings | Surgical wards, burns units, oncology skin-care clinics, home health with ordered wound supplies, ED boarding after major abdominal surgery |
What are Montgomery straps?
Montgomery straps (Montgomery ties) are adhesive strips placed parallel on either side of a wound. Each strip has holes along the inner edge; cotton tape, umbilical ties, or commercial lacing thread are woven through matching holes and tied like shoelaces to hold the dressing snugly without re-taping the patient’s skin at every change.
The system is common after large abdominal incisions, some burn dressings, and cavity wounds that need frequent inspection. Nurses still perform full wound measurement and ordered cleansing—the straps change how the outer dressing is secured, not whether standard wound assessment occurs.
Principles here align with public wound-care and infection-prevention sources in References. This guide does not reproduce proprietary text from licensed manuals; use your organisation’s wound protocol and The Royal Marsden Manual of Clinical Nursing Procedures via RMM Online procedures (institutional access may apply) for verbatim steps.
Montgomery straps versus tape-at-skin each change
Choose the securement method that matches wound size, drainage, and periwound skin integrity—not habit.
Parallel straps + lace ties
- Skin barrier and straps stay in place across multiple dressing changes.
- Only ties and inner dressings are replaced when soiled—less adhesive stripping.
- Suited to large abdominal wounds, some burns, and frequent dressing schedules.
Tape to periwound skin each time
- Works for small, low-drainage wounds with healthy surrounding skin.
- Repeated removal risks medical adhesive–related skin injury (MARSI).
- Each full change requires new tape placement and skin assessment.
Overview
On surgical and burns wards, nurses often meet patients whose dressings must be opened twice daily yet whose periwound skin is already pink, denuded, or hair-bearing and easily stripped. Montgomery straps let you lift the dressing by loosening ties instead of peeling tape from the same strip of epidermis every round.
Pair strap application with hand hygiene, gown and glove technique when splash risk exists, and pain assessment before manipulation. When erythema spreads or fever appears, think cellulitis or deeper infection and notify early—do not wait for the next routine strap change.
Document whether straps are new or maintained, tie tension, drainage on removal, and periwound skin colour so the next nurse knows if the lace—not the wound bed—caused new pain or creasing.
Indications
| Indication | Nursing rationale |
|---|---|
| Large abdominal or truncal surgical wounds | Provides even dressing pressure across a wide surface without circumferential tape. |
| Frequent dressing changes | Reduces MARSI when ties—not strap adhesive—are changed most often. |
| Fragile or hair-bearing periwound skin | Limits repeated adhesive trauma when ordered by the wound or surgical team. |
| Moderate to heavy drainage under physician-selected dressings | Allows securement while inner layers are changed per wound care orders. |
Contraindications and when to pause
- Active blistering, open rash, or moisture-associated skin damage where barriers cannot adhere safely
- Known allergy to strap adhesive, barrier film, or ordered cleansing solutions
- Uncontrolled bleeding or dressing soak-through requiring surgical review first
- Signs of systemic infection with haemodynamic change—follow sepsis screening per protocol
- First application on a new wound type (e.g. enterocutaneous fistula, exposed hardware) unless already in the plan
- Patient reports new chest tightness, dyspnoea, or severe pain when ties are tightened—may signal inappropriate tension over the trunk
- Periwound skin maceration from prior tape—may need alternative securement
Skin barrier placement and MARSI prevention
Medical adhesive–related skin injury often starts where tape is removed daily. Montgomery systems move that trauma away from the wound edge—but only if barriers and straps sit on intact skin prepared correctly.
Patients with type 2 diabetes or immunosuppression need tighter documentation of periwound integrity because minor MARSI can delay healing.
Lace tension: when to stop tightening
Ties should secure the dressing—not compress the trunk or shear periwound skin. Use lace tension as a bedside safety check every time.
| Cue | Likely meaning | Nursing action |
|---|---|---|
| Slight skin wrinkling between straps | Near maximum safe tension | Stop tightening; document baseline appearance |
| Patient reports sharp pain or “can’t breathe” after tie-down | Excess pressure over abdomen or chest | Loosen ties immediately; notify clinician |
| Dressing shifts but ties are already snug | Poor strap alignment or inadequate inner packing | Realign straps parallel to wound; review inner layers with wound team |
| Limb distal to site cool, pale, or numb | Rare on trunk but critical on proximal limb wounds | Loosen system; urgent perfusion assessment |
Equipment
Complete hand hygiene. Apply isolation precautions when the patient has transmissible infection beyond standard precautions.
Pre-procedure assessment
Procedure steps
Verify patient and orders
Two identifiers; confirm wound location, dressing products, and whether this is initial strap placement or tie change only.
Explain and position
Describe lace tying and expected pressure; position for lighting and access (often semi-Fowler for abdominal wounds). Offer analgesia per order.
Remove old dressing and assess
Cut ties or tape gently; assess wound and periwound skin. Perform ordered wound irrigation or cleansing before re-dressing.
Prepare periwound skin
Cleanse with saline; dry thoroughly. Apply skin barrier strips on intact skin where straps will adhere, parallel to the wound axis.
Apply Montgomery straps
Place paired adhesive strips on opposite sides of the wound with holes facing the dressing edge, spaced symmetrically. Manufacturer spacing varies—follow kit instructions. Date and time the strap when policy requires.
Layer the dressing
Pack or cover the wound per order (e.g. non-adherent layer, foam, gauze). For cavity wounds, see wound packing guidance when ordered.
Lace and secure ties
Thread tie material through matching holes on each side; knot like a shoelace. Tighten until the dressing is stable—stop if skin wrinkles excessively or the patient reports pain or breathing difficulty.
Change ties and inner dressing only
When straps and barriers remain adherent and skin is intact, loosen ties, remove soiled inner layers, re-dress, and re-lace. Replace straps or barriers when lifting, soiled, or per policy—intervals vary by manufacturer and service (often every 2–3 days for ties; barriers up to about 7 days when intact—institutional protocols may vary).
Dispose, hand hygiene, educate
Dispose of waste; perform hand hygiene. Teach the patient to report looseness, strike-through drainage, odour, or skin burning under straps.
Document
Record wound appearance, products, strap/tie status, tie tension tolerance, and next review. Link to broader plans when multiple wounds exist.
Dressing change workflow when straps stay in place
If barrier film peels or straps detach, plan full reapplication rather than stacking new adhesive over rolled edges—creases harbour moisture and bacteria.
Monitoring, complications, and escalation
| Finding | Concern | Nursing action |
|---|---|---|
| Strike-through or saturated dressing | Loss of barrier function | Change inner dressing promptly; notify if drainage increases unexpectedly |
| Erythema beyond wound margin with chills | Possible cellulitis or sepsis | Notify clinician; obtain wound culture per orders; track vital signs |
| Blistering or denuded skin under strap | MARSI or moisture injury | Stop reapplying straps over broken skin; wound team review |
| Wound edges gaping after tie-down | Dehiscence risk | Do not overtighten; urgent surgical review per protocol |
On a small screen, swipe or scroll sideways to see all columns.
Documentation
“20/05/2026 14:10 — Midline abdominal wound 12 cm; Montgomery straps (new) with barrier film bilateral flanks. Non-adherent layer + foam + gauze; umbilical ties laced, snug without skin creasing. Pain 3/10 post. Periwound intact, no erythema. Patient instructed to report looseness or strike-through. Next tie change 21/05/2026 AM per order.”
- Whether straps, barriers, or ties were new or maintained
- Wound measurements and drainage description
- Periwound skin and MARSI findings
- Tie tension tolerance and patient symptoms during securement
- Products used and patient education provided
Clinical pearls
- Align straps parallel to the wound—angled straps pull dressings sideways and shear skin.
- Cut ties long enough to lace without forcing the dressing into the wound bed.
- Mark strap date visibly so colleagues know when barrier replacement is due.
- For heavy drainage, confirm inner absorbency before tightening ties; straps cannot compensate for the wrong dressing layer.
Patient education
NCLEX practice questions
NCLEX-style clinical judgment practice — When ties bite before the wound does, lace tension and periwound skin tell the story—barrier placement, tie changes, and escalation during Montgomery straps application, including a priority action, select-all-that-apply cue recognition, trend interpretation after dressing care, and matrix escalation matching (recognise cues → analyse → prioritise → act → evaluate outcomes).
Unfolding case — surgical ward. Ms. Rivera, 58, is day 4 after laparotomy with a midline abdominal wound and new Montgomery straps ordered for frequent dressing changes. She reports the ties felt “too tight” after the last round. Periwound skin is pink; dressing shows moderate serous strike-through.
Answer key & rationale
Frequently Asked Questions
How often should Montgomery ties be changed?
Change ties when soiled or per order—often every 1–3 days. Straps and skin barriers may remain longer if adherent and skin is intact. Institutional protocols may vary.
Can patients shower with Montgomery straps?
Depends on inner dressing type and surgical instructions. Many midline wounds require protected showering or sponge bathing until cleared—follow the operative team plan.
How tight should the laces be?
Secure enough to stabilise the dressing without creasing surrounding skin or causing pain, dyspnoea, or nausea. Loosen if the patient reports tightness after the last change.
When should straps be fully replaced?
When barriers peel, straps lift, periwound skin blisters, or odour suggests contamination under the adhesive. Do not layer new straps over rolled edges.
Are Montgomery straps the same as negative pressure wound therapy?
No. NPWT uses sealed suction devices. Montgomery straps are a mechanical lace securement system for dressings. See negative pressure wound therapy for a different modality.
What should trigger urgent escalation?
Wound dehiscence, uncontrolled drainage, spreading erythema with fever, respiratory distress after tie-down, or suspected sepsis—notify per escalation protocol.
References
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National Institute for Health and Care Excellence (NICE). Surgical site infections: prevention and treatment (NG125).https://www.nice.org.uk/guidance/ng125
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Centers for Disease Control and Prevention (CDC). Standard Precautions for All Patient Care.https://www.cdc.gov/infection-control/hcp/basics/standard-precautions.html
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Royal Marsden Manual of Clinical Nursing Procedures — Procedures (RMM Online). Wound and skin integrity procedures (institutional subscription may apply for full text).https://www.rmmonline.co.uk/contents/procedures
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OpenStax. Clinical Nursing Skills. Rice University (open textbook) — wound care and dressing securement chapters.https://openstax.org/details/books/clinical-nursing-skills
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World Health Organization (WHO). Infection prevention and control in health care (overview hub).https://www.who.int/health-topics/infection-prevention-and-control
-
NHS. Accidents and injuries (wound care overview). NHS website.https://www.nhs.uk/conditions/cuts-and-grazes/
Editorial standards & medical review
About the author: Sid A. Abdala Balal, RN, writes evidence-based nursing education focused on practical bedside skills, patient safety, and clinical decision support for nurses.
Medical review: This guide is reviewed by Dr. Adam Sayedi, MD, for clinical accuracy, clarity, and alignment with current nursing standards for Montgomery straps application and wound securement.
Policies: Medical Review Process · Editorial Policy · Correction Policy