Almost every horse will require bandaging at some time. The use of bandages is very common – they may be applied over surgical sites or wounds, for support (e.g. in tendon or ligament injuries) or to prevent the limbs swelling during periods of box rest. Just because bandaging is common, it does not mean it is something that can be done any old way. Indeed, there is very much a correct way of bandaging and failure to bandage a limb properly can result in problems developing that are even greater than the original reason for applying the bandage!
The choice of bandage will differ according to the result desired, but most bandages include the same two to three layers.
Topical dressing- e.g. medicated pad, liniment, honey dressing. Generally used over surgical sites or when injuries or skin conditions are present.
Padding – rolls of synthetic orthopaedic padding, cotton wool or fabric quilt. This layer serves to absorb exudate (discharge) from any underlying wound and, when cotton wool is used, acts as the main source of stability in the bandage.
Compressive/securing layer e.g. vetrap, Elastoplast, stable bandage. This layer is to secure the bandage in place, to protect the bandage from soiling and trauma. This layer allows air to enter the bandage and fluid to evaporate, maintaining the integrity of the bandage and an optimal environment for the underlying skin.
Bandaging of a wound can prevent contamination, provide compression to minimise swelling, hold topical medications against the wound and convey exudates (wound discharges) away from the injury.
Excessive swelling or movement of the wound edges will inhibit healing and delay wound margin contracture. The ability of the edges of the wound to contract is an important factor in the healing process. A bandage that applies compression can help prevent fluid from accumulating in the limb.
Firstly, ensure you and your patient are in a clean hygienic environment with the wound or surgical site clean of any contaminating material and the appropriate hydrating substance applied i.e. clip, clean and apply hydrogel. The limb should be weight-bearing to permit the even application of the bandage.
Next, apply the wound dressing (or pad) directly over the wound.
Secure with several rolls of Orthoband (synthetic orthopaedic padding). This is an excellent product for conveying fluid, that seeps from the wound, away from the injury. It is impossible to apply Orthoband too tightly as the product will tear if excessive force used on it.
Depending on the size of wound or stability required, a layer of cotton wool roll can then be applied next. The cotton wool bulks out the dressing, providing stability to the underlying limb and to the bandage itself. Apply as evenly as possible so that after this layer is in place, the bandage resembles a symmetrical tube. It will pay at this stage to massage the bandage, smoothing out and lumps and bumps so that the surface is even and the bandaged area is supported equally all round.
This means the likelihood of developing pressure points, thereby damaging the underlying skin and causing pressure sores, is diminished.
Next a layer of conforming bandage is applied. This layer plays the vital roll of firming up the bandage. This may be performed by a Vetrap (elastic cohesive bandage) or a Knitfirm (knitted conforming bandage).
In the case shown, both have been used for extra support - the Knitfirm first followed by a vetrap. The conforming bandage can be applied under moderate tension as the more gently applied cotton underlayers protect against this conforming overlayer from causing any rubbing or stricture of the limb. As a rule of thumb, the vetrap should be applied under such tension that about half the wrinkles in it will have smoothed out.
Finally, an Elastoplast (elastic adhesive dressing) is applied at the top and bottom, covering the edges of the bandage. This will help guard against the dressing slipping and, in the case of the top end especially, prevent debris such as bedding material from working its way under the bandage.
A wound or surgical site is usually rebandaged every 3 to 4 days.
The purpose of the stable bandage is to protect the limb and to enhance lymphatic drainage. This will prevent the limb becoming swollen or, in a limb that is already swollen, assist in reducing swelling. Again, the limb should be first brushed down and then bearing weight when this bandage is applied.
Firstly, a quilted pad is applied. Wrap around the cannon neatly and evenly.
Next, the stable bandage is applied. Each circuit should overlap the previous circuit by about 50%. This facilitates a secure layer where the pressure is evenly distributed over the limb and minimising the potential for pressure points.
Preventing human injuries is every bit as important as treating equine ones. The person applying the bandage should avoid sitting or kneeling on the ground, instead choosing to crouch so that they are ready at any time to move out of the way quickly should that be necessary. Ensure a competent handler is holding the horse and if bandaging a region where the horse may kick out (e.g. over the hock), then carry out in an open area.
Don’t skimp on the padding – an evenly applied padding is vital for providing a supportive bandage. Being miserly with padding decreases the level of support and makes the development of pressure points more likely.
3. Careful with tension!
Anything directly against the skin should not be applied with tension. On the other hand, while the conforming layer should be applied with some tension, uneven application can lead to pressure points and associated damage to the underlying skin. The layers under tension should provide an even pressure over the bandaged area – firm but not too tight. N.B. As already mentioned, when applying rolls of bandage, it is best to overlap the circuits by about 50%.
4. Choose your own direction.
Clockwise or anti-clockwise is of no importance. What is important is the layers used and the technique.
5. Ask your vet’s advice
Remember, an incorrectly applied bandage can do more harm than good. If you are in any doubt, seek advice from your vet.