Bandaging and Bandaging Techniques-SA Spring 2025 PDF

CVM 737A Introduction to Surgery Bandaging and Bandaging Techniques-SA Spring 2025 Robert S. Gilley DVM, PhD, DACVS Professor and Chief Small Animal Surgery  Agenda Advantages and disadvantages/complications with bandages Indications for using...

CVM 737A Introduction to Surgery Bandaging and Bandaging Techniques-SA Spring 2025 Robert S. Gilley DVM, PhD, DACVS Professor and Chief Small Animal Surgery  Agenda Advantages and disadvantages/complications with bandages Indications for using a bandage The Soft Padded Bandage (Modified Robert Jones) Basic rules to remember during application When & where to use The three basic layers Application Techniques  Agenda General Types of Bandages, Splints, & Slings Casts Common complications Assessing and bandage changes Tips  Learning Objectives 1. Explain the advantages and disadvantages/complications with bandages. 2. List the three basic layers of a Modified Robert Jones (soft padded) Bandage and the functions performed by each. 3. Describe a tie-over bandage and when it would be appropriate to apply to your patient. 4. Summarize the pertinent factors that go into the decision to use a cast in the treatment of a fracture. 5. List the “rules to remember” when bandaging a small animal patient.  Advantages The goals of a bandage Protects wounds Speed wound healing  Disadvantages/Complications The complications with a bandage can… Result in limb amputation Kill your patient!  Bandage Injury Can happen to any clinician even when bandage is placed properly!  Bandage Injury can result in amputation - Pet owners will want to blame you! Owner education imperative!  Good things that bandages do: Provide wound cleanliness Control wound environment Reduce edema & hemorrhage Eliminate dead space drisk(compression of Seroma formation Immobilize injured tissue Minimize scar tissue Make patient more comfortable  Complications with bandages: Patient discomfort Patient mutilation of bandage & wound Bacterial colonization of wound Ischemic injury Damage to healing tissues Become a GI foreign body obstruction  Indications for Bandages Typically used below elbow & stifle Treating Injuries Bandages reduce Pain Swelling Local tissue damage Protecting wounds or devices For transport> - Robert Jones  Soft Padded Bandage (Modified Robert Jones)* ① Modified Robert Jones Immobilizes limb Decreases/limits soft tissue swelling Absorbs wound exudate Add splint material Premade, thermoplastics, fiberglass, aluminum rods *Fracture MUST be below the elbow / stifle Three Basic Layers of a Bandage: 1. Primary (contact layer) 2. Secondary (intermediate layer) 3. Tertiary (outer layer)  Functions of Primary Layer Debrides tissue Delivers medication Transfers wound exudate Forms an occlusive seal Minimizes pain Prevents excessive loss of body fluids Primary Layer TELFA common pads extremely - · breathable absorptive ·  Functions of Secondary Layer Absorbs & stores deleterious agents Retards bacterial growth Pads wound from trauma Splints wound to prevent movement Holds primary bandage layer in place  Secondary Layer cast padding ↳ Secondary Layer · "Cling" compression ·  Functions of Tertiary Layer Holds other bandage layers in place Protects against external bacterial colonization Cosmesis ~ cosmetic Tertiary Layer vet wrap  Types of Primary Layers Adherent Nonadherent Occlusive Semi-occlusive Primary/Contact Layer Selection Based on: Phase of wound healing Amount of exudate Wound location & depth Presence of~ absence of eschar ~ dried , dead adhered , piece of Skin Amount of necrosis or infection  Types of Primary Layers: Adherent vs. Nonadherent Adherent Used when wound debridement required May be wet or dry Nonadherent During repair phase or if no necrotic debris Retains moisture to promote epithelialization & prevent dehydration Drains excess fluid & prevents maceration  Types of Primary Layers: Occlusive Impermeable to air Use on nonexudative wounds to keep moist Speeds rate & quality of healing compared to dressings allowing desiccation Use in partial thickness wounds w/o necrosis or infection  Types of Primary Layers: Semi-occlusive Allows air to penetrate Allows exudate to escape Most commonly used primary layer  Applying a Soft Padded Bandage this order ! Bandage cat a Apply In 1. Tape Stirrups 2. Primary Layer 3. Secondary Layer 4. Tertiary Layer 5. Labeling Assemble Bandage Materials & Supplies  Applying Tape Stirrups Tape Stirrups Distal 1/3 of limb Medial & Lateral or Dorsal & Palmar/Plantar? Tabbed ends or tongue depressor to help separation Modified Robert Jones / Soft Padded Bandage Tip: one place dogs actually d hara Place cotton between toes Decreases moisture build-up Increases patient comfort Don’t forget dewclaw  Applying Primary Layer Contact layer Nonadherent +/- Medication Usually sterile Wicking  Applying Secondary Layer Intermediate layer Absorbent Supportive +/- Rigid support Applied Toes-up > proximal) (wrap distal e Overlapping ~ 50 % Firm, even pressure  Applying Secondary Layer Separate tape stirrups Rotate stirrups proximally while twisting 180° Secure stirrups to underlying wrap Prevents distal slipping Applying Tertiary Layer Outer Layer Applied Toes-up 7 Overlapping ~ 50 % i Firm, even pressure This is what clients see!= try to make presentable  Applying a Walking Pad Elastikon® or durable material Very adhesive Water resistant Applied w/o much pressure since elastic properties may lead to swelling Koozies!& Applying Labels Date Initials Reminders Warnings General Types of Bandages Absorbent Adherent Wet-to-dry (most common adherent) & No longer recommended Wet-to-wet (contact layer expected to stay wet) Dry-to-dry & No longer recommended Nonadherent Now recommended for all stages of wound healing Occlusive = prevents moisture loss  General Types of Bandages (Cont.) Semi Occlusive O Bandages most often used in vet med D Tie-Over Wound in area inaccessible by standard bandaging techniques Stabilizing Post-operative or Closed Wound Over closed incision or drain · ex TPLO ; bite. wounds  Tie-Over Bandage Wound in area inaccessible to standard bandaging techniques (e.g., hip, shoulder, axilla, or perineum) Contact & absorbent layers held in place w/ tie-over bandage  Tie-Over Bandage Tie-over bandage used to manage large open wound on lateral thigh of a 6-year-old Greyhound  Tie-Over Bandage stents - Apply several sutures or skin staples w/ loose loops around periphery of wound Apply primary & secondary bandage layers Hold tertiary layer by lacing umbilical tape or heavy suture through loose skin sutures or staples General Types of Bandages (Cont.) Pressure Relief Bandage Usually over bony prominence To treat/prevent pressure sores General Types of Bandages (Cont.) Pressure Bandage Facilitates control of minor hemorrhage, edema, & excess granulation tissue Direct application of corticosteroid ointment to wound helps control excess granulation tissue > - more used In LA The more convex the surface, the greater pressure exerted by dressing on tissue Adherent Bandages: Wet or Dry? How to decide?  Wet Adherent Bandages Wound surface has necrotic tissue, foreign matter, or viscous exudate Sterile wide mesh gauze soaked in: Sterile saline solution 1:40 (0.05%) Chlorohexadine diacetate Necrotic tissue & foreign material adhere to gauze & removed w/ bandage  Dry Adherent Bandages When wound surface has loose necrotic tissue & foreign material When wound has large quantity of low-viscosity exudate that does not aggregate  Bandages, Splints & Slings Robert Jones* - good for transporting Immobilizes Decreases/limits soft tissue swelling - high pressure Absorbs wound exudate ⑪ Soft padded (Modified Robert Jones)* 11 bandages Similar benefits as w/ Robert Jones "Workhorse of Add splint material Premade, thermoplastics, fiberglass, aluminum rods *Fracture MUST be below elbow / stifle  Robert Jones Vs. Modified Robert Jones Very large/thick bandage Uses rolled/sheet cotton Lots padding · or of cast Wrapped w/ more compression Soft padded (Modified Robert Jones) Similar benefits as Robert Jones Add splint material Premade, thermoplastics, fiberglass, aluminum rods  Proximal Extremity Lesions Continue bandage up leg, around chest or abdomen & between legs to create spica type bandage compete [  Paw Bandage Placed like leg bandage except digits are covered After placing stirrups & contact layer Reflect cast padding over digits from dorsal to ventral-then ventral to dorsal Wrap padding around distal limb Conform bandage to limb w/ elastic gauze Secure bandage w/ elastic tape in similar fashion  Schroeder-Thomas Splint Traction splint Labor intensive Soft tissue complications Lacks predictability - Frowned upon nowadays (too many complications) “Historical Significance” http://drssnairvet.blogspot.com/2014/12/modified-schroder- thomas-splint-for.html  Spica Splint For immobilization of shoulder  Ehmer Sling “Ehmer Femur” To prevent pelvic limb wt-bearing Post hip reduction or acetabular fractures  Velpeau Sling “Velpeau Elbow” To prevent forelimb wt- bearing After shoulder / forelimb procedures - medial shoulder luxations  Casts for Fractures Stable minimally displaced fractures Young rapidly healing animals Only injuries distal to elbow / stifle Unable to repair w/ surgical techniques Expense: Discuss w/ owner Can be an issue -maynotbecheaperlongtermranges , etc  Casts for Fractures (cont.) Swelling reduced prior to cast Greenstick fractures may not need sedation Displaced fractures => general anesthesia Open fractures: DO NOT CAST Always radiograph after casting & Must have >50% overlap of fracture ends In each of 2 radiographic views  Casts for Fractures (cont.) Check at least q2 weeks Weekly initially (if possible) Place cast w/ limb in standing position Encourages use when walking Limits muscle atrophy & joint stiffness Shortens recovery period after removal Tendon repair protection Support an arthrodesis!  Common Complications ⑪ Slipping / loosening Water or urine-soaked Joint stiffness & muscle atrophy Pressure sores Hard materials or constricting bands Prominences More padding = less well immobilized -  ① Checking and Changing Bandages require high degree of client compliance! Discharge should include verbal, written, & visual instructions for clients Check frequently Checking and Changing (cont.) Change frequency depends on: Age Activity Cleanliness Associated wounds Swelling  Assessing Bandage Clean Dry Protect during post-op recovery Hospital blue pads Plastic bag when going outside  Assessing Bandage (cont.) Comfort Chewing at bandage Lameness increase after discharge Assessing Bandage (cont.) & When to Remove Bandage: With these signs- Odor Swelling Toe Temperature Compare to other foot Nail bed cyanosis If ANY doubt=> Remove!  Special Consideration Cases Cats Bandage Paralysis Some Exotics  Rules to Remember ⑪ Sedation or anesthesia may be required Leave middle 2 toes (claws) exposed when possible Bandages start at toes & go up limb to avoid swelling  Rules to Remember (cont.) Keep limb in physiologic position Typically standingPosition (but laying down , esp. If Sedated) Do NOT apply w/ limb in full extension (straight) Overlap 1/3 to 1/2 the width of your wrap Apply firm even pressure during application Tension proportional to amount of padding & size of patient  Rules to Remember (cont.) Owner compliance - Key to success! No single dressing produces optimum microenvironment for all wounds or all stages of wound healing of single wound Identify underlying structures Mark the ear! Prevents iatrogenic injury  Small Animal Surgery Fifth Edition CHAPTER 15 Pages 194-204 Theresa Welch Fossum, DVM, MS, PhD Dewey, Horn, Johnson, MacPhail, Radlinsky, Schulz, Willard Copyright © 2018 by Mosby, Inc. an affiliate of Elsevier