By: Ashley Whitehead, DVM, BSc, DVSc, DACVIM
Learn the correct way to bandage wounds on limbs, from first aid to aftercare.
The long winter is over and you are ready to get outside with your horse and enjoy the warm weather… then it happens. You bring your horse in from the field and there is a wound on his leg. Fortunately, proper bandaging can help speed up your horse’s recovery.
Bandaging your horse’s limb when there is a wound does more than keep it clean. The bandage can prevent further trauma to the area and will help support tendons and ligaments during lay up in a stall. Proper bandaging will apply pressure that helps to stop bleeding, decrease dead space (open or expanded space between tissue layers) and decrease or prevent edema (fluid accumulation in the tissues). The bandage will also help to provide a clean and appropriate environment that promotes healing. Finally, proper bandaging can help limit movement to specific structures of the limb, allowing the tissue to heal faster.
Primary layer: Usually a non-stick wound dressing, such as a Telfa™ pad and a stretchy thin layer, such as Kling® wrap, to keep the wound dressing in place.
Secondary layer: A padding layer to absorb excess fluid and provide compression. The padding is usually secured and compressed with gauze prior to applying the tertiary layer.
Tertiary layer: A layer of self-adhesive elastic bandage, like Vetrap™, to protect the bandage from the environment and keeps the bandage secure. This layer should never get wet (otherwise bacteria and contaminants could penetrate through the bandage to the wound).
WOUND BANDAGING SUPPLIES
Going to a tack shop or veterinary pharmacy can be overwhelming, as there are so many bandaging options. If your veterinarian has assessed the wound, they will tell you what bandaging materials to use. Show your vet what supplies you have so they can assess what else you might need.
Don’t buy too much bandaging material, as over time bandages may become less adherent or stretchy and sterile supplies will expire. Have enough on hand to get you through a few bandage changes. Check your first aid kit every two or three months to make sure your material is clean and ready to dress an injury.
- Quilted wrap (reusable)
- Stable wraps/bandages (3- to 4-inch, reusable)
- Sheet or roll cotton (disposable)
- Brown or white gauze (4-inch, limited stretch)
- Non-adherent bandages (Telfa™ pads)
- Flexible stretch gauze wrap (3-inch, Kling®)
- Self-adhesive elastic bandages (3- to 4-inch, Vetrap™)
- Elastic adhesive tape (3- to 4-inch, Lightplast®)
- Non-elastic white tape
10 STEPS TO BETTER BANDAGING
1. Start with clean, dry legs and clean, dry bandages. This is critical and helps ensure that the wound won’t become macerated (tissue that has softened and broken down).
2. Apply the primary bandage layer over the wound. Ensure that there are no kinks, lumps, bumps or wrinkles. All layers should lie flat and be smooth against the skin and other layers of the bandages. This is especially important on those layers touching the horse’s skin.
3. Use adequate padding to protect the limb. The secondary layer of the bandage should have at least three centimetres (or more) of soft padding, such as disposable roll or sheet cotton or reusable quilted wrap.
4. Begin wrapping in the middle the cannon bone (or other long bone). You should not start or finish your leg wrapping over a joint because when a horse moves around, the joint motion will cause the bandage to loosen and shift.
5. Apply each layer by starting on the inside (medial aspect) of the limb and wrap over the front to the outside (lateral aspect) to the back and then to the medial aspect. This would be counter clockwise on left legs and clockwise on right legs. It is not wrong to wrap in the other direction, but it will be more difficult to apply the bandage correctly without pulling or putting abnormal pressure on the flexor tendons. Ensure that you do not pull across the back of the limb, instead apply appropriate tension as you pass the bandage across the front aspect of the limb.
6. Wrap in a spiral pattern, working down the leg and up again. Ideally, the end of the bandage is near the top of the bandage. This takes practice. When wrapping, overlap the preceding layer by about 50 per cent and apply smooth uniform pressure to compress the secondary padding.
7. The bandage should extend from the base of the carpus (knee) or hock to just below the coronary band. This prevents any swelling from accumulating below the bandage.
8. When you are wrapping the tertiary layer near the bottom and top of the secondary bandage layer, leave about one to two centimetres of padding visible. This will ensure that the tertiary layer won’t slip down and create a circumferential pressure spot.
9. If you have some elastic adhesive tape, you can make a small wrap at the top and bottom of the bandage. This helps to prevent any debris from getting under the secondary layer and the bandage stay in place.
10. If you need use tape to secure the tertiary layer, do not wrap it in a circle around the limb. Use a spiral to disperse the pressure down the leg.
BEFORE YOU BANDAGE
Your horse may need to be seen by a veterinarian if:
- the wound is a deep penetrating one;
- the wound is near or over a joint or tendon sheath;
- the wound is substantial;
- the wound might have debris inside it (like a splinter of wood or metal shavings);
- the horse is lame or does not want to stand on the limb;
- limb conformation is in an abnormal position;
- the wound can be sutured closed
If your horse’s wound does require a visit from your veterinarian, you can follow these simple tips while you wait:
- keep the horse in a quiet, clean confined area;
- wash the wound IF there is only minimal bleeding;
- do not apply ointments, chemicals or salves as these may make it more difficult for your vet to assess the wound and perform any repairs to the skin
HINTS AND TIPS
Practice: Bandaging takes practice. It is best to practice on your horse when it does not have an injury. This will allow you and your horse to get comfortable with the bandaging process.
Know your anatomy: Having a basic understanding of the structures in the horse’s limb will help you describe wound locations to your veterinarian and avoid damaging your horse’s limb during bandaging.
Even pressure: Make sure that the bandage has an even distribution of pressure from top to bottom and everywhere in between. The bandage should look uniform, like a stove pipe, and not lumpy or bumpy. If you need to bandage over a joint, consult your veterinarian for the appropriate method to do so, as incorrectly placed bandages can do more harm than good.
Amount of pressure: Getting the correct amount of pressure can be difficult. Too loose and the bandage will shift and fall down. Too tight and the blood supply can be compromised, resulting in pressure sores or a bowed tendon. Aim to stretch bandaging material by 50 per cent and wrap it so you can fit one or two fingers between the limb and secondary bandage layer. Vetrap™ bandaging should appear slightly waffled, not smooth.
Changing the bandage: Depending on the wound, you may need to change the bandage daily. As healing progresses you may be able to extend the time between changes. More padding is needed the longer a bandage is going to be in place. Even with a horse on stall rest, the bandage will loosen over the first 24 hours due to movement, so you must check the bandage regularly to ensure it is still in place.
Bleeding: If there is profuse bleeding, a pressure bandage is required. Follow the bandaging tips as above but increase the secondary padding layer. If the wound bleeds through the bandage do not remove the bandage – simply apply another pressure bandage on the outside of the first bandage. Continue to add layers if the bleeding seeps through.
Don’t hesitate to ask your veterinarian for more information or help as you perfect your bandaging technique.