Bandaging, Splinting, and Casting

Chapter 86Bandaging, Splinting, and Casting



Alan J. Ruggles, Sue J. Dyson


Indications for bandaging and cast application include protection of limbs during transport and performance, reduction of soft tissue swelling, protection of surgical wounds, management of skin defects and granulation tissue, protection of surgical implants, management of fractures, and first aid before transport of injured horses. This chapter discusses methods of bandage, splint, and cast application and the acute management of a horse with a suspected fracture or soft tissue injury.



Stable and Traveling Bandages


Bandages used routinely as stable bandages or for transport consist of a padded, quilted, fleece, or an interwoven sheet of cotton as a protective layer, held in place by a flannel wrap or commercially available bandage material. Horses that continually wear stable bandages tend to develop ridges in the hair coat, and this should be noted at a prepurchase examination. Proper bandaging prevents limbs from filling in a stabled horse and helps to prevent injury during transport. The coronary band region is particularly vulnerable during transport, loading, and unloading, and the bandage ideally should extend to cover this area. Alternatively, overreach (bell) boots should be used. Improper bandage application or management can cause the development of white hairs, transient edema, and structural damage to soft tissue structures and, under severe circumstances, pressure necrosis. An excessively tight bandage can result in severe tissue necrosis within 24 hours, resulting in full-thickness skin loss and damage to the underlying soft tissues. The midmetacarpal region seems to be particularly vulnerable. Alternatively, commercially available boots can be used for transport, the best of which extend from proximal to the dorsal aspect of the carpus, or the plantar aspect of the tarsus, to cover the coronary band. The use of exercise bandages and boots for protection and support is discussed in Chapter 37.



Bandaging Wounds


The principles of bandages used to protect wounds are to absorb exudate, reduce soft tissue swelling, and provide an environment conducive to wound healing. Each wound has its own characteristics that make a specific type of bandage, or even the absence of a bandage, ideal. All bandages prevent or reduce edema by providing pressure. A bandage can immobilize a region to a certain extent; the degree of immobilization depends on the type of material used and the manner of its application.


Surgical wounds are generally created under ideal conditions, and proper apposition of the skin edges occurs during suturing. Protection is provided by a nonadherent, porous dressing (Telfa, Kendall Co., Mansfield, Massachusetts, United States) over the wound. The dressing is held in place with a sterile gauze roll (Conform, Kendall Co.), and then a cotton combine roll 45 cm wide (for the lower limb only), or alternatively a soft conforming bandage (Soffban, Smith and Nephew, Hull, North Humberside, United Kingdom). The gauze is held in place with an elastic conforming bandage (Vet-Wrap, 3M Animal Care Products, St Paul, Minnesota, United States; Elastikon, Johnson and Johnson, Arlington, Texas, United States). These dressings are changed every 2 to 3 days, or earlier as needed, until suture removal. In some circumstances bandaging may be prolonged to reduce postoperative swelling and improve cosmetic results. If a full-limb bandage is placed to extend above the carpus or tarsus, an additional bandage 40 cm wide is applied above the first bandage. A layer of gauze is used over the combine and cotton, and an elastic conforming bandage (Elastikon) is then applied. Finally, additional elastic tape is used to secure the top of the bandage to the skin. These types of bandages are used postoperatively for most horses undergoing orthopedic procedures, such as arthroscopy or splint removal, and for most horses with limb wounds, assuming the limb is stable.


In a forelimb the area of the bandage over the accessory carpal bone is incised with a scalpel blade to prevent rub sores from developing. In a hindlimb the point of the hock can be covered by the bandage if duration of bandaging is anticipated to be less than 1 week. If prolonged bandaging is required, the point of the hock should not be covered, to prevent rub sores and potential development of white hairs.


Roll cotton (cotton wool) rather than combine roll may be used for the proximal portion of carpal bandages, because it stays in position best. Roll cotton is particularly useful for reducing soft tissue swelling after desmotomy of the accessory ligament of the superficial digital flexor tendon. A nonadherent layer and conforming gauze are covered by elastic adhesive bandaging tape before application of a full-limb padded bandage. This provides protection of the wound from the environment and prevents hematoma and seroma formation. Care must be taken to avoid excessive tension being applied to the elastic adhesive tape to prevent pressure necrosis.



Pressage Bandages


Pressage bandages (S.C. Meades, Cardiff, Wales) are commercially produced elasticized bandages designed specifically for the carpus and hock and available in three sizes. They provide an excellent method of securing a light bandage in place and providing pressure, with a minimal risk of pressure sores, and are used routinely by one author (SJD). Two turns of an elastic conforming bandage over the proximal extent of the Pressage bandage and application of a stable bandage in the more distal part of the limb help to keep the Pressage bandage from slipping.



Ether Bandages


Ether bandages are used to cover surgical incisions, but they do not provide any compression to the incision. For the ether bandage to stay, the area to which it is applied must be clipped or preferably shaved. Cleansing of the skin with surgical scrub, followed by alcohol rinsing, provides the best environment on which to apply this bandage. Strips of adhesive elastic tape approximately 15 cm in length are cut, and ether is applied to the adhesive side of the bandage tape. The ether-soaked bandage is then applied over gauze sponges and held in place while the ether evaporates and the adhesive dries to the skin and elastic tape. Three or four strips of elastic tape typically are used. Ether bandages are extremely adherent and very useful to protect surgical wounds made for stifle arthroscopy, bone grafts from the tuber coxae, and plate fixation of the olecranon (Figure 86-1). Because of the explosive nature of ether, proper precautions should be followed in its use and storage. Commercially available Primapore (Smith and Nephew) or Coverderm (DeRoyal, Powell, Tennessee, United States) dressings provide a simpler alternative but are less adherent.


image

Fig. 86-1 Application of an ether bandage over an incision for repair of a fractured olecranon in a yearling.



Stent Bandages


Stent bandages are towels or gauze rolls that are sutured over wounds to protect the wound from the environment or to relieve tension at the sutured site. A sterile hand towel or gauze sponges, rolled like a cigar to the proper width of the wound, are sutured over the wound with No. 2 or larger suture. A cruciate pattern is usually used. Stent bandages are used after shoulder arthrotomy, after olecranon or femur fracture repair, to cover wounds over the point of the hock, and for other incision sites unsuitable for bandaging. If the stent is to be changed routinely, then loop sutures are placed on both sides of the incision, and umbilical tape can be used as suture to hold the bandage in place between changes.



Wet-to-Dry Bandages

Related posts:

  1. Lameness in Horses: Basic Facts Before Starting
  2. Thermography: Use in Equine Lameness
  3. Counterirritation
  4. The Carpal Canal and Carpal Synovial Sheath

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Jun 4, 2016 | Posted by in EQUINE MEDICINE | Comments Off on Bandaging, Splinting, and Casting

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