Bandaging Tips

Bandaging Techniques for General Practitioners

Dr Abbie Tipler ATCL BVSc MANZCVS, VSS Surgical Resident

Bandages are applied to protect wounds, absorb exudate, relieve pressure, stabilise (often in conjunction with a splint) or to administer medications. External coaptation is the use of a bandage, splint or sling to manage a fracture.

There are several down-sides to bandaging - cost, skin redness, chafing, bruising, ischemic injury and potential lack of bone healing. In one study of 39 patients, 63% had soft tissue complications. (20% moderate, 20% severe). Complications are more common in sighthounds. Prolonged immobilisation leads to rapid loss of muscle mass, loss of joint motion and loss of cartilage thickness and stiffness. Early, protected limb use is used to maintain joint motion and eliminate edema in the post-operative period and coaptation may negatively impact these goals. It should not be used to offset weak fixation.

Complications can be severe and in one study of 11 dogs, ischemic limb injury required limb amputation, skin grafts and toe amputation in these dogs. The key to avoiding complications is to give the owners good home-care instructions. They should alert the veterinarian to any slipping, soiling, damage, change in sensation, chewing, soreness, coolness of the toes or lameness. Ischemic injury often occurs within the first 24-48 hours of bandaging and complications could be avoided with careful bandage monitoring. Clients should check the toes for divergence by removing the outer layer of the dressing if there are concerns.

For bandage changes, keep the changes quick by having everything ready. This avoids exposure to the environment which leads to moisture evaporation and compromise of wound healing.

There are several layers to a bandage; Stirrups should be applied first and don't need replacing every time.

The contact layer is in contact with the wound. There are a few options for this and ideally we match the contact layer with the type of wound and amount of exudate such that the wound bed is kept moist and the skin is kept dry. It needs to be sterile, especially prior to the formation of granulation tissue.

The intermediate layer holds the primary dressing in place and is absorbent and stabilising. If you apply a splint, this is applied to the outside of the intermediate layer and it is wise to record the number of intermediate layers (generally 3-5) if applying a splint so it can be repeated. Apply circumferentially with even tension. Start distal and go proximal, then proximal to distal then a third layer distal to proximal. The last layer should end proximally, which reduces venous trapping. The more layers there are, the less likely you are to create a tourniquet or necrosis injury. Take care with your elastic layers, not to place them too tight. You should be able to place a finger between the bandage and skin. Avoid having toes exposed, as you risk a tourniquet effect with toe swelling.

Finally, the outer layer should be a porous layer so that fluid in the intermediate layer can evaporate which avoids skin maceration.