Bandaging 101: A Wrap for all Reasons
A pressure bandage can help stem the flow of blood from a wound. This is especially critical for cuts involving arterial bleeding.
By: Dr. Felicity Wills |
Bandages create a protective barrier of padding and/or cloth wraps, mainly for the purposes of wound care on various parts of a horse’s body and to support and shield his legs during and after exercise or travel. There are five main reasons we bandage:
1. to apply pressure during an emergency, first aid situation
2. to protect and support wounds while they are healing
3. to prevent or reduce edema (swelling) after exercise or during stall rest
4. to support and protect tendons, ligaments and joints from concussion, impact and trauma during exercise
5. to protect and support legs during transport and stabling
Emergency First Aid: A pressure bandage can help stem the flow of blood from a wound. This is especially critical for cuts involving arterial bleeding, as the bandaging keeps the pressure in place while the horse is transported to veterinary care.
Wounds: After treatment, a bandage protects wounds from further trauma as well as contamination from the environment. Bandages restrict movement around the wound, giving tissues a chance to knit together without reopening. A sterile, non-stick layer under the bandage also absorbs fluids and secretions from inflammation or infection.
Prevent or Reduce Edema: Stable bandages create compression around the leg, preventing the development and deposition of edema fluid, often referred to as ‘stocking up.’
Exercise: Exercise bandages can prevent a horse from self-inflicted trauma, such as over-reach injuries, as well as trauma caused by external objects like jump rails, polo mallets and trailers, for example. Studies suggest that exercise wraps may also help protect a horse’s bones and joints against concussive forces (shockwaves) that occur when his limbs strike the ground. They may also help to protect against hyperextension injuries that are brought on by fatigue.
Transport and Stabling: Stable bandages or standing bandages provide a barrier against bumps and support from fatigue. This is important for horses travelling long distances and for horses that may be confined due to injury. For example, if a horse’s front leg is injured, the owner should wrap both front legs for support, since the horse will transfer some of its weight from the injured leg to the non-injured leg. The same is true for hind legs, but it is less critical, as the hind legs proportionally bear less weight than the front legs. It’s best to consult your veterinarian, as the horse’s injury and length of stall rest will determine its needs.
Choosing and Using the Right Materials
There are many different types of materials available for bandaging, but all address a few specific purposes: wound coverage, padding, support and protection. Using the right type is essential to applying a safe and effective bandage. Depending on your purpose, you’ll need to consider things such as the degree of padding, absorbency and tendency to stick (particularly in the case of open wounds), breathability and width.
Most wound bandages use between two and four layers. First, a sterile, non-stick, absorbent dressing is placed over the wound and secured with flexible stretch gauze wrap. Second, a layer with an ample amount of padding is used to absorb excess fluid. It is sometimes secured and compressed with gauze. Third, a support layer of self-adhesive elastic bandage, like Vetrap™, is applied. Fourth, a protective outer layer of duct tape or electrical tape can be used if necessary.
Stable or standing bandages commonly use a square of thickly quilted cotton as padding. Any bandage that is required for a long period of time will need padding underneath the wrap. The outer wraps should measure about three to four inches wide to help evenly distribute pressure. Bandages under two inches wide can create a tourniquet effect, disturbing blood flow to the limbs. They may have a slight ‘give,’ but should not be elastic. Never use a tensor bandage on a horse’s leg, as it can restrict blood flow.
For exercise bandages, fleece polo wraps with Velcro® fasteners are commonly used, as are various types of exercise boots.
Best Bandaging Techniques
The type of bandage and the correct technique/material differs greatly between each situation, so it is best to seek advice before applying a bandage or using a new bandaging product. However, the following is a list of helpful hints for bandaging the most commonly bandaged area – the legs:
• Begin with clean, dry legs and bandages.
• Determine how much you need to bandage. Most stable bandages cover from just below the knee to just above of the fetlock. If transporting or protecting a lower leg injury, the padding and wrap should extend all the way to the heel bulb. For exercise wraps, you may want to wrap only the cannon bone, or you may want to provide additional support by wrapping below the fetlock.
• Provide adequate padding. As a general rule, the layer of padding should be at least three centimetres in thickness to adequately cushion and protect the leg. Always make sure there is about three centimetres of padding showing above and below the outer bandage.
• Apply correct tension. The greatest challenge when it comes to bandaging a horse’s legs is achieving the right degree of tension. The ideal tension for a correctly applied leg bandage is best described as ‘snug.’ The bandage should be tight enough to remain securely in place, but not so tight as to restrict blood flow.
• Make wraps smooth and even. Leg bandages are wrapped in a spiral pattern. Each wrap you make around the leg should overlap the preceding layer by about 50 per cent to ensure consistent, even distribution of pressure. Bandages and padding should lie flat and smooth with no wrinkles.
• Wrap ‘tendons in,’ from front to back, outside to inside (counter-clockwise on left legs, clockwise on right legs). This ensures tension from the bandage is applied to the front of the leg rather than on the delicate tendons at the back of the leg.
• Start the wrap over bone at the inside front of the leg. Never start or finish the wrap over the tendons, which may damage the softer tissue, or over a joint as the constant movement will loosen the bandage and may cause it to bunch or unravel.
• Check leg bandages frequently and re-bandage if necessary. As a general rule, standing bandages should not be worn for longer than 12 hours at a time, while wound bandages should usually be changed daily.
Bandaging is not always helpful for all wounds. There is some evidence that bandaging can help promote proud flesh, so once wounds are past a certain stage, it may be better to leave them unbandaged. Horse owners will need to discuss the pros and cons with their veterinarian and determine their horse’s individual needs.
The Risks of Improper Bandaging
In many cases, if you are unsure how to properly apply a bandage, it’s safer not to. For first aid bandages, ask your veterinarian to show you how to apply one during a routine check-up visit, and then practice. It’s the one thing you’re going to need the most in an emergency situation. If you’re considering bandaging for exercise or transport, practice with an experienced bandager beforehand.
Uneven pressure is the biggest risk of improper bandaging, particularly the legs. Anything that creates a pressure point on the back of the leg can cause damage to the tendons, sometimes called a ‘bandage bow.’ Bandages placed too tightly or without adequate padding can restrict blood flow and lead to tissue death. Bandages placed too loosely will slip or even come undone, which can cause rub wounds and pressure injuries.
Overheating is another risk that horse owners may not be aware of. Leaving bandages on for long periods, particularly during transport and exercise, can lead to overheating of the soft tissue structures that may be linked with an increased risk of injury. A recent study on tendon cores overheating showed damage under bandages with temperatures three degrees higher than normal.
Exercise boots can also do damage, just as wraps can. They can be easier to learn to put on, but can also cause overheating and pressure points. Limbs should be clean and dry before protection is applied. Dirt, moisture and sweat can lead to secondary skin irritation, inflammation or infection. It’s always a good idea to hose legs off after exercise and routinely disinfect boots and bandages.