Lecture 13- Bandaging and Bandaging Techniques

Goals of a bandage

Protect wounds and speed wound healing

Major risk of bandage complications

Limb amputation or death

Can bandage injuries occur even when placed properly

Yes — owner education is essential

Benefits of bandages

Provide cleanliness, control wound environment, reduce edema/hemorrhage, eliminate dead space, immobilize tissue, minimize scar tissue, improve comfort

Complications of bandages

Discomfort, self‑mutilation, bacterial colonization, ischemic injury, tissue damage, GI obstruction if ingested

Typical locations for bandages

Below elbow and stifle

Indications for bandages

Treat injuries, reduce pain/swelling, protect wounds/devices, transport stabilization

Modified Robert Jones bandage purpose

Immobilizes limb, decreases swelling, absorbs exudate, can incorporate splint

Fracture requirement for MRJ bandage

Fracture must be below elbow or stifle

Three layers of a bandage

Primary, secondary, tertiary

Functions of primary layer

Debrides, delivers medication, transfers exudate, forms occlusive seal, minimizes pain, prevents fluid loss

Functions of secondary layer

Absorbs/stores debris, retards bacterial growth, pads wound, splints wound, holds primary layer

Functions of tertiary layer

Holds layers in place, protects from external contamination, improves cosmesis

Types of primary layers

Adherent, nonadherent, occlusive, semi‑occlusive

Primary layer selection based on

Wound healing phase, exudate amount, location/depth, eschar presence, necrosis/infection

Adherent primary layer use

When debridement is required; wet or dry

Nonadherent primary layer use

Repair phase or no necrotic debris; retains moisture; prevents dehydration; drains excess fluid

Occlusive primary layer characteristics

Impermeable to air; used on nonexudative wounds; speeds healing; for partial‑thickness wounds without necrosis/infection

Semi‑occlusive primary layer characteristics

Most common; allows air penetration and exudate escape

Steps of soft padded bandage application

Tape stirrups → primary layer → secondary layer → tertiary layer → labeling

Tape stirrup placement

Distal 1/3 of limb; medial/lateral or dorsal/palmar; tabbed ends or tongue depressor

Tip for toe comfort

Place cotton between toes; don't forget dewclaw

Primary layer application

Nonadherent, sterile, wicking, +/- medication

Secondary layer application

Absorbent, supportive, applied distal→proximal, overlapping, firm even pressure

Securing stirrups

Separate, twist 180°, rotate proximally, secure to wrap to prevent slipping

Tertiary layer application

Outer layer, distal→proximal, overlapping, firm even pressure

Walking pad purpose

Protects distal bandage; uses Elastikon; applied without pressure

Bandage labeling

Date, initials, reminders, warnings

Absorbent bandage type

Wet‑to‑dry, wet‑to‑wet, dry‑to‑dry

Wet‑to‑dry bandage status

No longer recommended

Dry‑to‑dry bandage status

No longer recommended

Nonadherent bandage use

Recommended for all wound healing stages

Semi‑occlusive bandage use

Most commonly used in vet med

Tie‑over bandage indication

Wounds inaccessible to standard bandaging (hip, shoulder, axilla, perineum)

Tie‑over bandage technique

Skin sutures/staples with loops → primary/secondary layers → lace tertiary layer with umbilical tape

Pressure relief bandage use

Over bony prominences to treat/prevent pressure sores

Pressure bandage use

Control minor hemorrhage, edema, excess granulation tissue

Effect of convex surfaces on pressure bandages

More convex = greater pressure exerted

Wet adherent bandage indication

Necrotic tissue, foreign matter, viscous exudate

Wet adherent bandage materials

Wide mesh gauze soaked in saline or 0.05% chlorhexidine diacetate

Dry adherent bandage indication

Loose necrotic tissue or low‑viscosity exudate

Robert Jones bandage characteristics

Very thick, uses sheet cotton, high compression

Modified Robert Jones bandage characteristics

Thinner, similar benefits, can add splint material

Proximal extremity lesion bandaging

Extend bandage up leg and around chest/abdomen → spica bandage

Paw bandage difference

Digits covered; padding reflected over toes; conform with elastic gauze

Schroeder‑Thomas splint

Traction splint; labor intensive; soft tissue complications; unpredictable

Spica splint use

Immobilization of shoulder

Ehmer sling use

Prevents pelvic limb weight‑bearing; post‑hip reduction or acetabular fractures

Velpeau sling use

Prevents forelimb weight‑bearing; shoulder/forelimb procedures

Indications for casts

Stable minimally displaced fractures, young animals, distal to elbow/stifle, non‑surgical candidates

Contraindication for casts

Open fractures

Radiographic requirement for casts

Must have >50% overlap of fracture ends in 2 views

Cast monitoring frequency

Weekly initially; at least every 2 weeks

Cast placement position

Limb in standing position to encourage use

Cast benefits

Reduces atrophy, reduces stiffness, shortens recovery, protects tendon repair, supports arthrodesis

Common bandage/cast complications

Slipping, loosening, moisture, pressure sores, joint stiffness, muscle atrophy

Padding vs immobilization

More padding = less immobilization

Client compliance importance

Critical for success; requires verbal/written/visual instructions

Bandage change frequency depends on

Age, activity, cleanliness, wounds, swelling

Bandage assessment criteria

Clean, dry, protected during recovery

Signs bandage should be removed

Odor, swelling, cold toes, cyanotic nail beds, any doubt

Rules to remember: sedation

Sedation/anesthesia may be required

Rules to remember: toe exposure

Leave middle two toes exposed when possible

Rules to remember: direction

Start at toes and wrap proximally

Rules to remember: limb position

Keep limb in physiologic position; not fully extended

Rules to remember: overlap

Overlap wrap by 1/3-1/2 width

Rules to remember: pressure

Firm, even pressure; tension proportional to padding and patient size

Rules to remember: owner compliance

Key to success

Rules to remember: no universal dressing

No single dressing is ideal for all wounds or stages

Rules to remember: identify structures

Mark the ear to prevent iatrogenic injury