7: Bandaging and Casting Techniques for Wound Management

Bandaging and Casting Techniques for Wound Management

Updated by Yvonne A. Elce, DVM, Diplomate ACVS


Bandages and splints or casts are an essential component of wound management and, when used properly, can greatly aid healing. Improper application, however, may impede healing and be detrimental to the well‐being or athletic future of the horse. Many different types of bandage materials exist and are reviewed in Chapter 6. The current chapter is devoted to the principles and techniques of bandaging and casting. Splinting is discussed along with casting because either approach may be used when immobilization is required to support wound healing. Various techniques to improve the application and maintenance of bandages, splints, and casts, as well as to manage complications arising from their use, are discussed.


Bandages, splints, and casts can be valuable aids to the healing of various wounds. Bandages protect the wound from the environment, as well as from repeated trauma. By keeping the area warm and moist, they improve cellular metabolism and migration within the wound bed. Moreover, bandages may absorb exudate and/or decrease tissue edema through mild compression. In general, bandages enhance wound healing, if properly applied and if they are adapted to the phases of wound healing. Bandages, however, may also wield some disadvantages besides the costs associated with their long‐term use. Of particular concern, they may increase the risk of formation of exuberant granulation tissue (EGT) in wounds located at the distal aspect of the limb (the reader is referred to Chapter 15 for more information on equine EGT).1–4 Wounds that produce a copious amount of discharge may suffer tissue maceration if the dressing is not adapted to this situation and if the saturated bandage is not replaced in a timely manner. Moreover, incorrectly applied bandages can damage the wound surface and/or cause inflammation in the soft tissues underlying and surrounding the wound.

Although a thick bandage decreases movement in a wounded area, a splint or cast is a more appropriate choice when immobilization would aid healing. Splints are generally applied over a well‐padded bandage and decrease movement, whereas casts, applied over a bandage or not, provide the most rigid immobilization. Immobilization with a splint or cast is generally reserved for wounds over high‐motion areas, such as joints (e.g., fetlock or carpus), and it should be kept in mind that even short periods of immobilization can negatively affect the health of joints and bones.5,6

Thus, in all cases, the benefits of bandaging and/or splinting or casting should be weighed carefully against the potential negative effects that may result from the improper use of bandages, splints, and casts.



Bandages generally consist of three main layers.7 The primary layer is in direct contact with the wound, the secondary layer is thicker and usually composed of cotton padding, while the tertiary layer is commonly the mechanism whereby the other layers are held in place.

The primary layer, or wound dressing, must be adapted to the nature of the wound, especially as it pertains to the phase of healing. Of the many types available, most modern dressings are considered “interactive” and are designed to either support debridement, maintain a humid wound environment, allow the passage of oxygen and/or exudate, enhance epithelialization, or exert some combination of these actions (the reader is referred to Chapter 6 for an update on the various types of wound dressings).

The secondary or intermediate layer is composed of thicker material, such as cotton or gauze, designed to absorb excess exudate not managed by the dressing, to provide padding and to limit motion somewhat.

The tertiary layer, while passive, provides some compression to decrease swelling and aids in restricting movement of the limb. Elastic, adhesive, or self‐adhesive materials are commonly used for this purpose (Table 7.1).

Table 7.1 Common examples of materials used for the secondary and tertiary layers of a wound bandage.

Bandage material Purpose Company
Kling™ Conforming gauze to support the dressing Johnson & Johnson, Guelph, ON, Canada
Curity Synthetic undercast padding™ Conforming gauze to support the dressing Covidien, Mansfield, MA, USA
Bandage gauze Conforming gauze to support the dressing Shoof International Ltd, Cambridge, New Zealand
Gamgee Highly Absorbent Padding Secondary layer 3 M, St Paul, MN, USA
Curity practical cotton roll Secondary layer Covidien
Curity wadding rolls Secondary layer Covidien
Cotton wool roll Secondary layer Shoof International Ltd, Cambridge, New Zealand
Vetrap™ Tertiary layer 3 M
Shoof‐Vet cohesive bandage Tertiary layer Shoof International Ltd, Cambridge, New Zealand
Kendall adhesive bandage Tertiary layer Covidien
Powerflex bandage Tertiary layer Andover, Salisbury, MA, USA
Veterinary Elastic Adhesive Tape Tertiary layer 3 M
Elastikon® Elastic Tape Tertiary layer Johnson & Johnson
Bandage elastic adhesive Shoof Tertiary layer Shoof International Ltd, Cambridge, New Zealand
Co‐Ease cohesive bandage Tertiary layer Tempo‐medical products, Scottsdale, AZ, USA

Wound bandaging in horses usually includes these basic three layers, with some modifications according to the specific area being bandaged. Bandages applied to the head and to the foot, for example, may not comprise all three layers.

General considerations

Horses with bandages and/or splints or casts should be kept in a clean, dry area that allows for frequent visual monitoring. A clean stall or small pen with grass may be used.

Bandages should be changed regularly to avoid tissue maceration due to the excessive accumulation of exudate that is not absorbed adequately by the primary and secondary layers. The required frequency of bandage change is dictated by the nature of the underlying wound and the selected dressing.

The tertiary layer must be applied with even tension and over sufficient padding so as not to cause excessive pressure, particularly at the distal aspect of the limb where there is little soft‐tissue coverage. Elasticized bandage should not be applied directly to the skin, so a small amount of the secondary layer is left uncovered proximally and distally. Adhesive tape is then applied, without tension, over those uncovered areas of the secondary layer and overlapped on to the skin. This final touch prevents foreign material from migrating under the bandage and causing skin sores or contaminating the wound.

Specific bandages

Foot and pastern bandages

Wounds to the foot are usually the result of penetrating objects or of the foot becoming caught between two surfaces. Bandages are used to cover wounds on the sole of the hoof, the coronary band or the pastern. If there is a large defect in the sole, initial bandaging used during the acute phase of healing may be followed by the long‐term use of a specialized shoe, such as one with a removable plate covering the sole. If there is a defect involving the hoof wall, the hoof wall surrounding the wound is trimmed slightly shorter so that the shoe contacts the wall of the hoof, as normal, except at the affected area. A foot cast and/or a specialized shoe is necessary when a substantial portion of the hoof wall has been lost because it helps provide long‐term stability to the rest of the foot during the lengthy healing and regrowth of the horn.

Wounds of the sole, hoof, or pastern first receive generic cleansing and debridement, followed by primary closure, if warranted. A dressing suitable to the state of the wound is then applied (Figure 7.1a,b), followed by a secondary layer of cotton. For wounds on the sole, a large square of cotton can be placed on the bottom of the foot and folded up over the wall of the hoof and the coronary band then attached with elastic, self‐adhesive material (Figure 7.1c,d). A square patch of duct tape placed on the bottom of the foot, over the square of cotton, prevents wicking of moisture from the environment (Figure 7.1e). Finally, elastic, adhesive tape is lightly applied, circumferentially, to the top of the bandage and the surrounding skin, to prevent foreign material from migrating under the bandage (Figure 7.1f,g).

Photos displaying (a–f) the process of how a penetrating injury to the sole of the foot of a horse being cleaned, irrigated, covered with sterile gauze, wrapped with self-adhesive material, and bandaged in place.

Figure 7.1 (a) A penetrating injury to the sole of the foot has been cleaned, irrigated, and covered with sterile gauze. (b) Conforming gauze (Kling™ or Conform) can be used to hold the primary layer in place on the bottom of the foot. (c) A cotton pad is folded into a square and then placed over the sole of the foot with the edges drawn up and over the foot and coronary band. (d) Elastic, self‐adhesive material (Vetrap™) is used as a tertiary layer to hold the cotton in place. (e) Duct tape is used to make a patch in a square or a cross configuration to be placed on the bottom of the foot. It is best to do this on a clean metal surface and not a painted wall as the paint may peel off when the patch of duct tape is removed. This patch is centered over the sole of the foot with the edges coming up around the sides of the foot bandage. (f) To complete the foot bandage, elastic adhesive tape is applied (without tension) over the skin to prevent bedding or dirt from entering between the bandage and the skin/hoof. The final bandage provides some padding to the injured foot but also absorbs drainage and protects from further contamination. (g) A view of the bottom of the foot with the bandage in place. The horse should be kept in a clean and dry environment to complement the action of the protective, waterproof duct tape.

Pastern wounds involving the coronary band or heel bulb regions are bandaged in a manner similar to those on the hoof except that the bandage extends proximad to cover the wound in the pastern region. Most of these wounds are best managed with a phalangeal (foot/pastern) cast, discussed later. Lacerations of the mid and proximal pastern region may be managed by bandaging the region without including the bottom of the foot. In this case, elastic adhesive tape is used to attach the distal extremity of the bandage to the hoof wall (Figure 7.2).

Photo displaying a bandaged hoof for wounds of the pastern region in a horse.

Figure 7.2 For wounds of the pastern region it is preferable to attach the bandage to the hoof to prevent upwards migration of foreign material under the bandage.

Distal limb bandages (extending from the ground to the carpus or tarsus)

Practitioners are usually comfortable applying a bandage to the distal aspect of the limb of horses because this is a commonly traumatized area in their equine patients8,9 and because bandages conform more readily to the metacarpus/metatarsus or fetlock than to the foot. The primary layer of the bandage (dressing) must suit the nature of the wound and is usually held in place with conforming gauze (Figure 7.3a). The thicker part of the secondary layer, consisting of cotton, is then applied (Figure 7.3b) and held in place with the tertiary layer, commonly elastic, self‐adhesive wrap such as Vetrap™ (Figure 7.3c). This tertiary layer must be applied evenly, distad to proximad, leaving a small border of the secondary layer exposed at either extremity to avoid applying pressure directly to the skin. These borders are then covered loosely by an elastic, adhesive tape, such as Elastikon®, that overlaps onto the skin to prevent the entry of foreign material under the bandage (Figure 7.3d). Horsemen are commonly taught to wrap the limb in such a way that the bandage material passes from outside to inside across the palmar/plantar surface of the limb: left limbs are wrapped counter‐clockwise, and right limbs are wrapped clockwise.

Photos of the first step in creating distal limb bandage on the wound (a), cotton padding applied (b), tertiary layer with self-adhesive material used (c,d), and bandage used to cover wound over cannon bone (e).

Figure 7.3 (a) The first step in creating a distal limb bandage is to place a dressing on the wound or suture line. This is held in place with some soft roll gauze, such as Conform. (b) Cotton padding is used as the secondary layer of a distal limb bandage. It must extend distally past the coronary band; it is important to avoid finishing the bandage directly over the coronary band where it may rub and cause irritation. The cotton layer protects the limb and may absorb excess exudate. (c) The tertiary layer, consisting of elastic, self‐adhesive material, is applied using even pressure. It must cover the underlying layer of cotton except for a small border both proximally and distally, in an effort to avoid placing undue pressure on uncovered skin. (d) Elastic, adhesive tape is then applied, without tension, both proximally and distally to cover the extremities of the bandage and prevent bedding or dirt from migrating under the bandage. (e) This distal limb bandage is used to cover a wound over the cannon bone; consequently, it need not be attached to the hoof. The distal extremity rests a few centimeters above the coronary band thus sparing it from rubbing and irritation.

Carpal and tarsal bandages

Carpal and tarsal bandages resemble the bandages applied to wounds on the distal aspect of the limb, apart from two main considerations: they are more challenging to apply and maintain and they have a greater potential of causing pressure sores over areas with little soft‐tissue coverage (e.g., the accessory carpal bone in the forelimb and the point of the hock in the hindlimb). Some measures can help protect against the development of cast sores related to bandages on the carpus or tarsus. For the carpal area, the conforming gauze used to secure the wound dressing can be wrapped in a figure‐of‐eight pattern around the carpus (Figure 7.4a), thereby relieving some pressure on the accessory carpal bone and simultaneously filling in the relative depression surrounding it. Thus, when the main part of the secondary layer (i.e., the cotton pad) is applied (Figure 7.4b), pressure is distributed evenly to the palmar surface of the carpus rather than to a focal point (accessory carpal bone). Alternatively, the layers can be applied as usual and then a small “releasing” incision can be made in the tertiary and secondary layers, directly over the accessory carpal bone, to relieve pressure at this area (Figure 7.4c–f). Another method of preventing excessive pressure on the accessory carpal bone is to create a donut of conforming gauze or rolled up stockinette and positioning it so that the hole is over the accessory carpal bone. This can be placed between the conforming gauze holding the primary layer in place and the secondary layer of cotton padding. This effectively prevents pressure on the bone when correctly positioned but, since the donut may slip, increased rather than decreased pressure may arise at a point under the bandage. Ultimately, the method used to reduce pressure on the accessory carpal bone when bandaging this area should be tailored to the materials available and the behavior of the patient.

6 Photos displaying the steps in creating a carpal bandage of the wound of a horse.

Figure 7.4 (a) The first step in creating a carpal bandage is to place an appropriate dressing on the wound or suture line. This is gently held in place with conforming gauze that can be placed in a figure‐of‐eight pattern around the carpus. (b) The secondary layer of cotton padding is applied as for a distal limb bandage, taking care to avoid bunching. (c) The tertiary layer is applied using even tension and overlapping by 50% the width of each turn of the elastic, self‐adhesive material. (d) The bandage with the tertiary layer in place; note the snug fit required to avoid bandage slippage and bunching that would be detrimental to both the wound and the skin of the limb. (e) The top and bottom of the bandage can be attached to the skin using elastic, adhesive tape, applied without tension. Placement of a stall bandage distally would eliminate the need for the lowermost band of tape and may help prevent distal slippage of the carpal bandage. (f) To prevent the development of a pressure sore over the protuberance of the accessory carpal bone, a releasing incision is made in the bandage directly overlying this site. This protuberance can be palpated through the bandage.

The conformation of the hock and the combination of forces generated by the reciprocal apparatus impose some important considerations when applying a bandage to this region. Horses are reluctant to accept restricted movement of this area and frequently disrupt the bandage by hyper‐flexing the hock. Placing the conforming gauze in a figure‐of‐eight pattern around the point of the hock (calcaneal tuberosity) not only relieves pressure but is also useful in preventing bandage slippage. When the tertiary layer is applied over the point of the hock, less tension should be exerted to allow unrestricted flexion of the hock. Moreover, elastic adhesive tape must be used to secure the bandage to the skin at its proximal and distal limits. Figure 7.5 shows the progression of bandage placement over the hock. Because the bandage may split over the point of the hock when the horse flexes its limb, a strip of elastic tape may be placed along the plantar surface, over the tertiary layer of the bandage, to reinforce that area without increasing pressure on the underlying skin (Figure 7.6). Placing a distal limb bandage after applying a tarsal or carpal bandage is often helpful to prevent the latter from slipping distally (Figure 7.7). Many horse owners find the hock difficult to bandage due to its conformation. Consequently, they may use various readily available materials, such as pantyhose or Velcro strips, to create an innovative bandage. The veterinarian must remain in contact with the owner and frequently verify that all is well with the horse and its bandage to ensure against constriction or rubbing.

3 Photos displaying the progression of bandage placement over the hock.

Figure 7.5 (a) A hock bandage is fashioned similarly to a carpal bandage. The selected dressing is applied to the wound and held in place using conforming gauze that is applied, in a figure‐of‐eight pattern, above and below the point of the hock. (b) The secondary layer is placed by conforming the cotton pad around the tibia and then slightly bunching it around the cannon bone when the tertiary layer is applied. As is the case with a forelimb bandage, the tertiary layer must be applied using snug, even tension and making sure to leave some cotton distally and proximally so as to avoid exerting pressure on unprotected skin. Moreover, less tension must be used when running over the point of the hock, to allow this joint to flex in spite of the bandage. (c) The proximal and distal extremities of the bandage can be sealed with loose turns of elastic, adhesive tape. More can be used proximally to help prevent distal slippage of the bandage.

3 Photos displaying a strip of adhesive tape on the plantar surface of the hock, strip of Elastikon® held in place at its proximal limit, and the proximal and distal limits of the strip secured with the same tape.

Figure 7.6 (a) Alternative hock bandage. A strip of elastic adhesive tape (e.g. Elastikon®) is placed longitudinally over the plantar surface of the hock region. (b) The strip of Elastikon® is held in place at its proximal limit by circumferential rolls of the same tape. (c) Bandage complete; both the proximal and distal limits of the strip of Elastikon® are secured with the same tape. The strip of Elastikon® helps limit disruption of the bandage during hock flexion.

Courtesy of Dr. D. Peters.

Photo displaying the addition of a distal limb bandage to help hold the carpal or tarsal bandage in place.

Figure 7.7 The addition of a distal limb bandage may help hold the carpal or tarsal bandage in place. Moreover, in the acute phase of wound healing, this bandage may aid in controlling the development of edema distal to the wound.

Restricting carpal flexion by applying a full‐limb bandage may be beneficial if the wound is located on the dorsal surface of the carpus. To apply a full‐limb bandage, cotton padding is used to cover the entire limb (from the coronary band or fetlock to the proximal radius) once the dressing has been secured over the wound. The separate rolls of cotton used to span the entire distance should be overlapped to avoid the formation of a gap between two rolls. An elastic, self‐adhesive material, such as Vetrap™ is then applied as a tertiary layer in the same fashion as for a distal limb bandage, and a relieving incision is made over the area of the accessory carpal bone. It may be easier to first apply all layers of the distal limb bandage and then add the proximal bandage, overlapping slightly at the proximal cannon bone; this avoids the need to hold the full length of cotton padding in place while applying the tertiary layer of Vetrap™. A full‐limb bandage can be applied in similar fashion to the hindlimb; in that case, the tertiary layer must be applied with less tension over the point of the hock than over the rest of the limb.

When greater restriction of flexion is desired, a compact, multi‐layered bandage, known as a Robert Jones bandage, can be applied. This might be appropriate when managing a wound over the plantar surface of the hock or a transversely oriented wound across the dorsal surface of the carpus; in both these instances, joint flexion would force the wound edges apart. In the case of a Robert Jones bandage, multiple secondary and tertiary layers are applied consecutively to the limb to build a uniformly compact bandage encompassing the entire limb. This thicker bandage will limit movement more than would a simple bandage.

Alternatively, a splint can be added to the palmar surface of a conventional forelimb full‐limb bandage, or a full‐limb cast can be used. In the case of a wound to the hindlimb, a splint made from cast material can be applied dorsally to a full‐limb bandage to partially immobilize the hindlimb or a full‐limb cast can be applied to support the repair of a large wound on the plantar surface of the metatarsus. The benefits provided by a full‐limb cast should be carefully weighed against the potential negative consequences (discussed in the following section on splints and casts).

2 Photos displaying rectal sleeve sliced lengthwise and attached over the plantar surface of the bandage (left) and cranial view of the rectal sleeve acting as a rain jacket (right).

Figure 7.8 (a) A rectal sleeve can be sliced lengthwise and attached over the plantar surface of the bandage. This should help protect it from becoming wet and may also reduce the ability of the horse to rub the two limbs together in an effort to dislodge the bandage. (b) Cranial view of the rectal sleeve acting as a “rain jacket.”

Head bandages

A head bandage is useful to protect the repair of a head wound or a wound left open to heal by second intention, and to exert a small amount of pressure that might control the development of subcutaneous emphysema in the case of sinus penetration. Special attention to positioning and maintaining a head bandage is required to avoid ocular trauma or occlusion of the nostrils.

A simple head bandage consists of an appropriate dressing, followed by the placement of a mesh stockinette (Figure 7.9a) over the head, with holes cut out for ears and eyes (Figure 7.9b). The extremities of the stockinette can be attached to the skin with an elastic adhesive tape such as Elastikon®, placed without tension, half on the stockinette and half on the adjacent skin (Figure 7.9c). An extra length of elastic adhesive tape may span the stockinette where it covers the dressing, in an effort to secure the dressing to the surface of the wound and prevent slippage under the stockinette (Figure 7.9d). Additionally, gauze may be slipped under the stockinette over the dressing to exert gentle pressure on the wound, if required. The elastic adhesive tape can be wrapped in a figure‐of‐eight pattern between the eyes and around the mandible, rostral to the eyes, and then behind the ears and under the mandible, if more pressure is required to prevent emphysema or swelling from developing (Figure 7.9e). This is useful for wounds involving the sinuses. Care should be taken to avoid wrapping too tightly around the rostral extent of the bandage, which might prevent the mouth from opening, or around the throatlatch region, which could hinder swallowing or breathing. A finger should slide easily between the bandage and the skin of the throatlatch. Following enucleation, the figure‐of‐eight pattern with one length of the elastic adhesive tape passing over the incision is used to apply gentle pressure to the wound and to prevent the horse from rubbing the sutures. This figure‐of‐eight bandage is also used following repair of fractured frontal bones.

Photo displaying a box of Surgilast tubular elastic stretch net dressing retainer (a) and four photos of a horse with mesh stockinette on the face and adhesive tape (b–e).

Figure 7.9 (a) Mesh stockinette is very useful when making a head bandage, due to its natural elasticity and the ease with which it can be torn to form eye and ear holes. (b) The mesh stockinette is drawn up over the head, tearing or cutting generous holes for the eyes and ears. Care must be taken to avoid occluding the nostrils or rubbing the eyes. (c) The two extremities of the mesh have a tendency to roll up thus uncovering the wound or interfering with the eyes. An elastic, adhesive tape (such as Elastikon®) can be applied, with light tension, to fix the two extremities to the skin. (d) The elastic, adhesive tape can be placed over the frontal sinus area and then looped around the face, rostrally, and behind the ears, caudally. The loops must be placed without tension but the tape may exert a small amount of compression on the dressing over the wound. (e) Elastic, adhesive tape has been looped behind the ears. Where the bandage passes under the throatlatch area, care must be taken to ensure it is not too tight; a finger should be easily inserted between the bandage and the underlying skin.

Commercial fly masks and helmets designed for the transport of horses may also be used either on their own or alongside bandages. Commercial masks with eye cups are recommended to protect an injured eye that is receiving treatment. Elastic head wraps, developed commercially for the purpose of “calming” a horse, make excellent head bandages and can be used over the stockinette in place of the elastic adhesive tape, although they are not useful for applying pressure, if that is required.

Bandaging ears that have been lacerated or partially amputated is challenging; care should be taken to avoid wrapping too tightly (the reader is referred to Chapter 11 for more information on bandaging an ear).

Thoracic and abdominal bandages

When a wound is located on the thoracic or on the abdominal wall, bandaging is sometimes required to prevent the formation of ventral edema or the accumulation of fluid in dead spaces, due to gravity. Conversely, bandaging is usually not indicated for wounds involving the axillary or inguinal areas. In these cases, the wound opening should remain as unobstructed as possible to allow ventral drainage and to avoid the trapping of air within the wound and surrounding subcutaneous tissues, which could lead to the development of emphysema.

To bandage a wound in the thoracic or abdominal area, the dressing is placed against the wound and overlaid by a secondary layer of cotton padding. The tertiary layer is then applied to hold everything in place and to mildly compress the wound. The best way to hold the bandage in place is to wrap the tertiary layer, often an elastic adhesive tape such as Elastikon®, around the circumference of the trunk. To ensure appropriate tension without restricting breathing, there should be room for a finger to slide easily under the bandage. Body bandages require a large amount of material and, consequently, they can be costly. An alternative to the classical tertiary layer is an adaptable commercial abdominal bandage (Figure 7.10). Because it can be laundered, it is especially useful for exudative wounds that require frequent bandage changes.

Sep 15, 2017 | Posted by in GENERAL | Comments Off on 7: Bandaging and Casting Techniques for Wound Management

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