CVC 2008 Highlights: Avoid common bandaging mistakes in dogs and cats
TAKE CARE AND TIME TO KEEP THE WOUND HEALTHY
You can apply Halstead's principles of surgical technique to veterinary wound care as well: Use gentle tissue handling, don't compromise the blood supply, control bleeding, and be as aseptic as possible—use sterile technique when cleaning the wound and when changing bandages.And don't be in a rush to get the wound to heal—the time it takes depends on the wound. It's important not to leave something (e.g. excess suture material, necrotic tissue, bandage material from a previous bandage, medications known to impede wound healing) behind that will impede wound healing. Keep the wound as healthy as possible so the body can heal the wound efficiently.
CHOOSE THE RIGHT BANDAGE
When you are choosing a bandage to protect the wound and help it heal, keep the condition, the patient, and the client in mind:
The bandage you select will depend on the condition you are treating. Are you treating an open wound that needs to be kept covered as it heals? It is common to apply a wet-to-dry bandage that is converted to a nonadherent bandage once a granulation bed develops and the wound is properly débrided. With the advent of some of the newer products available, we have a better selection of materials. This gives us the chance to apply the appropriate material to the particular wound.
Are you treating a patient with a fractured limb that only needs immobilization until surgery can be performed or until the wound can heal properly? Your best option may be a soft-padded bandage that incorporates a lateral splint. Or in a patient that has a closed fracture distal to the elbow or stifle that risks becoming an open fracture without stabilization, a Robert-Jones bandage will work well.
Is the injury a luxation that can be managed with an appropriate bandage? For example, a simple elbow luxation once reduced can be managed with a spica splint, or a craniodorsal hip luxation that is stable after closed reduction can possibly be managed with an Ehmer sling.
One bandage doesn't fit all. The bandage you select for an energetic 10-month-old Labrador retriever must be considerably stronger than the bandage you select for a 10-year-old Labrador retriever. For example, a midshaft nondisplaced greenstick tibial fracture may respond well to a lateral splint in an older patient that is sedentary, but you may want to consider a full-cylinder cast in a younger pup. Choose a bandage that is appropriate for the patient. Important factors to consider are age, activity level, species, size, body weight or conformation, and current health status.
Find out how well the owner can maintain the bandage. A bandage can become more of a detriment than a benefit if it isn't cared for properly. In some cases, you may even elect not to place a bandage if an owner can't provide appropriate home care. For example, certain fractures (e.g. a nondisplaced greenstick fracture involving a distal extremity) or luxations and subluxations may be amenable to external coaptation, but if the owner will be unable to manage the patient or the bandage, then surgical stabilization may be a better option.
You'll also need to know whether the owner can present the patient for routine bandage changes. The timing of bandage changes is crucial. If the bandage is placed perfectly but the patient isn't presented for a bandage change at the right time, the bandage can worsen the condition. For example, a wet-to-dry bandage placed over a severe open wound that is left on the limb for a week when it was supposed to be changed daily can be disastrous. Maceration of previously healthy tissue may ensue, making the wound more susceptible to infection, or the bandage may harbor bacteria, resulting in or exacerbating an infection.