Bandages

Bandages are applied to cover wounds protected by dressings, to prevent edema formation after injuries of the limb, and to support the limb in conjunction with an added splint in the case of a ligament injury or fractured bone.15,16 The type of bandage is chosen on the basis of the location and the nature of the injury.

Foot Bandage

Foot bandages are applied to manage a variety of problems. Part of a roll of cotton is placed over a primary wound dressing (Figure 17-13). The padding is secured with gauze, and it can be held in place with either cohesive or adhesive bandaging tape. Duct tape placed over the bottom of the bandage will render the bandage more durable and less permeable to urine and water (see Figure 17-13).15 Moisture can be kept from entering the bandage by placing plastic over the foot. An empty 5-L fluid-bag can be opened with a pair of scissors and placed over the hoof capsule and fastened with adhesive tape, attaching it effectively to the foot. This type of bandage is useful if it is desirable to exclude water from the wound environment, when a poultice or soak is applied to the foot, or when preparing a foot or pastern for any type of aseptic surgery.

Lower Limb Bandage

A lower limb bandage is applied from the bulbs of the heel up to just below the carpus or tarsus. It usually consists of a roll of cotton or sheet, applied in the standard clockwise fashion (pulling the tendons to the inside) (Figure 17-14). The underlying medical problem dictates the thickness, or number of layers, of the bandage. Each layer is secured with conforming roll gauze, wrapped snugly in a spiral pattern overlapping half the tape width, to prevent the padding from slipping or bunching. The gauze is overlaid with either adhesive or cohesive bandaging tape to secure the bandage in position. A single wrap of adhesive tape around the bottom of the hoof and the top of the bandage prevents bedding materials from gaining access to the underlying skin or wound, respectively. Care should be taken to extend the bandage to the level of the carpometacarpal or tarsometatarsal joint and to prevent inadvertent tendon damage if a considerable amount of tension is applied to the elastic bandage tape. At the level of those joints, the tendons are lodged between the vestigial metacarpal bones, which provide protection. Additionally, the coronary band should be included in the bandage so that tape can be applied directly to the hoof capsule.

Full Limb Bandage

Forelimb

A full limb bandage is applied from the bulbs of the heel up to the elbow region (Figure 17-15). When applying a full limb bandage, movement of the carpus requires that special attention be given to this area to prevent decubitus ulcers. The bandage is usually stacked, beginnning with a lower limb bandage followed by proximal limb bandages, to prevent slippage and subsequent irritation over bony prominences. Padding materials are the same as for the lower limb bandage and therefore require placement in two stages. The distal bandage is initially applied as previously described. The proximal part is subsequently added on top of the lower limb bandage, overlapping it for 5 to 10 cm. Applying a doughnut-shaped cotton ring or incising the gauze over the accessory carpal bone helps prevent skin irritation over that area and potential development of skin ulcers. Tightening of the bandage in layers provides more stability and increases the support. If the bandage becomes displaced distally, it is imperative that it be changed at once to prevent skin ulcers from developing over bony prominences.

Hindlimb

Motion of the tarsus requires special attention when applying a bandage to that region. Primary wound dressings are held in place using gauze applied in a figure-of-eight pattern (Figure 17-16). The crossing of the “8” occurs over the dorsal aspect of the tarsus, with the loops applied around the proximal metatarsus and the distal tibia of the limb, leaving the point of the hock open. Caution should be used in applying tension over the gastrocnemius tendon. The bandage is also applied in two steps, as described for the forelimb. The proximal part of the bandage overlaps the distal bandage. Applying soft cotton patches medially and laterally between the tibia and the gastrocnemius tendon provides support and reduces the pressure of the latter, thereby serving as protection against tendon damage that could result from excessive tension. Each layer of padding material is first secured with gauze, applied at a right angle to the limb, as opposed to the figure-of-eight pattern for the primary dressing. Application of cohesive or adhesive tape completes the bandage (see Figure 17-16). The bandage is finished by applying elastic adhesive tape around the hoof capsule below and to the skin on top of the proximal end of the bandage, thus preventing access of bedding to the skin underneath the bandage.

The application of a full limb bandage to the hind limb decreases the movement of all joints in the limb because of the reciprocal apparatus. Some horses have more problems coping with this situation, especially when rising from recumbency. Therefore, the patient will need to be observed for a while after such a bandage is applied