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.
APPLY THE RIGHT BANDAGE THE RIGHT WAY
After you've chosen an appropriate bandage, keep these tips in mind to ensure you've applied a comfortable bandage.
Obtain sufficient coverage
When you bandage extremities, the bandage should always begin at the toes and extend proximally. If you place a bandage around only a stifle or an elbow without including the distal extremity, you risk causing lymphatic or venous compression, and edema commonly occurs distal to the bandage. Other examples include wounds in the midfemoral or midhumeral areas. It is often difficult to keep a bandage in place that is wrapped only around the limb, so in these situations, you may have to encompass the pelvis or thorax, respectively, in the bandage.
Apply snugly, pad appropriately, and be neat
Apply the bandage snugly but not too tightly. Many bandaging materials can cause a tourniquet effect if you inadvertently overtighten them. Applying a bandage too tightly can result in the loss of the limb. Some materials are easy to overtighten, such as self-adherent bandages (e.g. Vetwrap—3M) and stretch or elastic gauze (e.g. Elastikon—Johnson & Johnson). Be prepared for any swelling that may occur, and monitor frequently.
Appropriate padding varies depending on the circumstances. A soft-padded bandage with appropriate immobilization to protect a healing skin graft may have just a few layers of synthetic cast padding in the secondary layer, but a Robert-Jones bandage contains several layers of rolled cotton to provide compression and temporary splintage. If too much padding is placed, you may lose needed support for the condition you're treating or you may make the bandage cumbersome.
Be neat. An appropriately placed bandage looks good. It is snug and tidy, not loose and sloppy. The bandage should stay solidly in place when the patient walks out the door.
Monitor frequently and provide timely changes
Whether the patient is hospitalized or at home, someone needs to check the patient and its distal extremities for swelling several times a day. A bandage may be placed correctly, but because of the underlying condition, swelling may ensue and the bandage becomes too tight. Tell owners to monitor a bandage extra closely when it has been newly changed. That is a time when problems commonly arise.
Bandages should be changed in a timely manner. In some cases, a bandage should be changed every day or even twice a day (e.g. a wet-to-dry bandage placed on a degloving wound). In other cases, the bandage may need to be changed only once a week or longer. For example, bandages that incorporate a splint to protect a healing fracture that has been surgically repaired or to protect various skin grafts after the initial adherence phase may need to be changed only once a week. Keep in mind that it is seldom appropriate to leave the same bandage on for two or more weeks. Full-cylinder casts placed for treatment of certain fractures are one exception—they may be kept in place for six to 10 weeks. But they still need the diligent monitoring required of all bandages.
Assess for comfort
A young dog may chew on any bandage you place, no matter what. But if a patient is chewing at its bandage, consider whether the bandage is uncomfortable and creating a problem for the patient. Did the bandage slip or twist? Or is something beneath the bandage causing pain or discomfort? The problem may or may not be easily identified, but if any doubt exists about the cause, remove the bandage and start over.
Some small animals, especially puppies or kittens, may chew at a bandage out of boredom. You can use various deterrents such as safe chew toys, or you can apply bitter apple or orange products to the bandage. Sometimes you'll need to place Elizabethan or BiteNot (Bite Not Products) collars.
Jayce Lineberger, DVM
5914 Johnson Drive
Mission, KS 66202