3 Equine Bandaging Techniques

• Equine bandaging, splinting and casting techniques is a bandaging resource
• The objectives are to recall the layers of a bandage and the purposes of each layer as well as describe the appropriate application of each bandage type

Bandage Purposes

• Protection for wound/surgical sites.
• Support of tissues and stress relief.
• Restriction of movement.
• Wound healing friendly environment creation.

Bandage Materials and Layers

• Bandages have 3 layers
• The primary layer is the contact later and serves as the wound dressing.
• The secondary layer serves as padding
• The tertiary or outer layer is the compression layer, or layers
• They are then sealed with adhesive elastic tape

Wound Dressing: The Contact Layer

• There is a wide variety of products to use as the contact layer with many different properties
• These products interact with the wound and contribute to the wound healing process.
• Conforming gauze can be used to hold the layer in place

Dressing Types and Their Uses

• Gauze is used for exudate absorption and superficial debridement when applied without a non-adherent covering
• Alginate is used for exudate absorption and promoting hemostatic, inflammatory, autolytic debridement and proliferative stages of wound healing
• Cellulose/hydrofiber is used to promote moist wound healing/granulation and is similar to alginate but not for use in bleeding wounds
• Chitin/chitosan is used for the control of hemorrhage following initial wound occurence
• Hydrogel is used in clean acute wounds that are non-exudative/dry to promote autolytic wound debridement and initial moist wound healing, but not for infected wounds
• Hydrocolloid is used in clean acute wounds during the inflammatory and early proliferative phases of wound healing, but not for infected wounds
• Foam. is used for exudate absorption and wound moisture maintenance in exudative wounds once the wound is filled with granulation tissue as well as promotes epithelization and wound contraction.
• Silicone is a fully occlusive wound dressing used to control and prevent occurrence of exuberant granulation tissue

Secondary Bandage Layer

• Is typically composed of cotton either disposable or non-disposable with or without an outer liner to hold the cotton together
• Gambgee and Rediroll/combiroll are common brands but plain sheet cotton or loose cotton roll can be used
• It serves as a purpose to absorb fluids, provide padding to protect from trauma and restrict motion of the limb

Tertiary Bandage Layer

• Can be comprised of one, two, or more different materials
• Non-elastic woven gauze initially with 6” brown gauze
• A cohesive bandage is next with a 4” width
• A reusable polo wrap can substitute the polo wrap
• It is then sealed with elastic and adhesive tape
• The purpose is to provide compression, protect the limb and bandage layers and further reduce motion

Basic Equine Bandages

• Foot bandage
• Distal limb bandage
• Stent bandage
• Full limb/stack bandage

General Bandaging Comments

• Be sure to wrap all layers in the same direction.
• Wrapping successive layers in opposite directions will undo some of the tension of the previous layer
• By convention in the equine industry, bandages are wrapped “toward the inside” of the limb
• Counterclockwise is for left legs and clockwise if for right legs
• Wrapping opposite the convention will not harm the horse but may result in judgement
• Position the bandage material so that it unrolls onto the leg
• It is often said to “wrap the tendons in
• Maintaining equal tension on the bandage material is very important
• Unequal tension will create pressure sores on the skin and/or a tendon injury known as a “bandage bow”

Personnel Safety

• Be aware and stand clear for hind limb bandages, as patients may violently kick or hyper-flex the limb when first walking

Unsafe Positioning:

• The handler is on the opposite sides of the bandagers
• The handler is backed into a corner and cannot escape with the horse possibly swinging over top of the bandagers
• Both bandagers are kneeling on the ground with one in front of the strike zone
• Neither person is paying attention to the entire horse
• Bandage materials are scattered on the ground, causing a tripping hazard, contamination risk, not readily available bandages
• The assistance is unprepared to help the primary bandager

Safe Positioning:

• All personnel are on the same side with room to escape
• The horse has room to move away if it becomes frightened
• The bandager is squatting, not kneeling, in a safe location and is facing the bandaged rear limb
• The assistant is standing in a safe location, out of the kick zone
• The assistant is standing at the ready with needed materials

Foot Bandage

• Foot bandage is also known as a boxing glove bandage
• It can be used for lacerations of the coronary band and dorsal pastern, not involving the heel bulbs
• It can be used for bandaging hoof abscesses after draining and combined with a soaking bandage to help draw out an abscess
• Optional soaking boot for hoof abscess bandage can be used for 24 hours and the soak can be removed after 20-30 minutes.
• After any wound dressing application, if not being soaked, a secondary bandage layer is applied & held in one hand
• A non-elastic gauze such as brown gauze is applied as tightly as possible to cover the entire foot
• There should be cotton showing at the top of the bandage
• A cohesive bandage is applied tightly in a similar fashion, pulling hard enough to remove wrinkles

How to Make a Duct Tape Boot for a Foot Bandage

• Overlap strips of tape wide enough to cover the hoof
• Rotate the tape 90° and repeat the overlap
• Cut an “x” pattern from the corners and leave the center area uncut and large enough for the hoof to fit in
• Apply the center of the pad over the sole
• Fold the wings up and wrap the foot
• Place the foot down and smooth/seal the tape edges and apply elastic tape to secure the pad and seal the bandage
• An alternative “+” style uses less tape and no cutting but may not seal as well

Distal Limb Bandage

• Distal limb bandages are typically used for wounds located in the proximal pastern up to the proximal metacarpus/metatarsus
• It can also be applied as a support bandage to remove edema or soft tissues in an overloaded limb with a severely injured contralateral limb
• A ptrolatum impregnated gauze wound dressing with antibiotic powder is applied as a primary bandage layer and held in place with conforming gauze
• The secondary bandage layer is applied as smoothly as possible
• The cotton should be adjusted so that the top ends just distal to the carpus/tarsus and the bottom lies either in the mid-pastern region or at the level of the heel bulbs
• The initial part of the tertiary layer is wrapped with 50% overlap, typically in the form of non-elastic brown gauze to compress the cotton roughly 70-80% of the final bandage
• The gauze layer, although standard practice, is optional and can be omitted, but this will result in much less effective bandage compression.
• The material may be started either in the center or at the top to of the bandage
• Once an initial wrap is taken to secure the material, a substantial amount of tension is applied
• Brown gauze may be applied with enough tension to nearly rip it
• Cohesive bandage should be applied with enough tension to fully remove the crinkles and give the material a smooth appearance
• The bandage is wrapped distally, then proximally while overlapping 50% of the material each wrap in order to prevent the material from bunching, the bottom edge may be pulled distally

Distal Limb Bandage

• The cohesive bandage is applied similar to the brown gauze
• This achieves the final 20-30% of the compression in the bandage and serves to stiffen the bandage while also providing a layer of protection
• The top &/or bottom is sealed with elastic tape

Full Limb Bandage

• Full limb bandage aka stack bandage is used to bandage the upper part of the limb
• It is a more supportive and secure bandage than just an upper limb bandage
• The lower bandage is applied as usual and may either finish the lower bandage with cohesive bandge or move on to the upper bandage after applying just brown gauze.
• The upper bandage is applied like the lower, centering the cotton padding over the point of the hock or accessory carpal bone
• The upper and lower bandages should overlap a minimum of one finger's width but as much as one hand's width
• The brown gauze and cohesive bandage may either be kept separate between upper and lower or they may be wrapped continually for the entire length of the bandage, effectively tying the bandages together
• The top and bottom of the bandage is sealed with elastikon
• A bandage material may be cut over the accessory carpal bone or figure 8 around the calcaneus to relieve pressure and reduce the risk of pressure sores
• Alternatively, if the horse is known to rip bandages due to excessive hock flexion, elastic tape may be applied to strengthen the bandage

Stent Bandage

• Also known as a tie-over bandage
• Used in areas not easily covered by limb bandages: neck, chest, upper limb, chest, abdomen
• Place anchor sutures, leaving open loops, by taking large bites, several centimeters away from the wound and loosely tying with large size non-absorbable suture
• Place the sutures similar to shoe lace eyelets in spacing and sufficient to span the wound
• Typically size 1, 2, or 3 non-absorbable suture
• Note that the anchor loops will pull out in several days, so plan your spacing and tissue bites accordingly to deal with this
• Err on the side of very large bites and place more anchor sutures more closely together so that they can handle loosing some as the wound heals
• Have an assistant hold your primary and secondary bandage layers in place while you place umbilical tape in the loops of your anchor sutures in a shoelace fashion
• Tighten the umbilical tape sufficiently to hold the bandage in place yet loose enough for patient comfort

Carpal Bandage

• A carpal bandage is applied similarly to other limb bandages but without the lower bandage support
• The pro is that there is less bandage material used, but the con is that they ay slip distally and require prematurely re-bandaging

Tarsal Bandage

• A tarsal bandage is also applied similarly to other limb bandages with the same pros/cons of a carpal bandage but without the lower bandage support

Head Bandage

• Can be applied post-enucleation or laceration repair
• Gauze is first applied to ease bandage removal
• Wrap carefully to avoid impinging on the patient's eye(s)

Ether Bandage

• Can be applied in difficult to bandage areas and is best done immediately following surgery
• Trim the elastic adhesive bandage to remove corners & frayed edges
• Then apply the ether to melt the adhesive and quickly apply to the patient

Abdominal Bandage

• Can be applied to protect incisions or wounds
• These will not apply substantial pressure to the area, only cover it.
• Brown gauze aids patient comfort during removal.
• Dressing changes can easily occur by cutting the ventral aspect & leaving the rest in place if not excessively soiled.