1.BANDAGING PRINCIPLES AND TECHNIQUES DR. SATYAJEET SINGH DEPARTMENT OF VETERINARY SURGERY AND RADIOLOGY

2. LECTURE OBJECTIVES Review bandage layers Functions and indications for specific bandages General bandage care Complications 3. GENERAL FUNCTIONS Aid in wound healing Prevent open wound contamination Wound debridement Maintain moist wound environment Support or protect deeper body partsSupport or protect deeper body parts PressurePressure Prevent/reduce swelling or hemorrhagePrevent/reduce swelling or hemorrhage Prevent weight bearingPrevent weight bearing Immobilization of tissuesImmobilization of tissues Often serve multiple functionsOften serve multiple functions 4. EVERY WOUND DESERVES A BANDAGE 5. A REAL BANDAGE 6. A REAL BANDAGE 7. GENERAL FUNCTIONS Aid in wound healingAid in wound healing Prevent open wound contaminationPrevent open wound contamination Wound debridementWound debridement Maintain moist wound environmentMaintain moist wound environment Support or protect deeper body parts Pressure Prevent/reduce swelling or hemorrhage Prevent weight bearing Immobilization of tissues Often serve multiple functionsOften serve multiple functions 8. IMMOBILIZATI ON 9. GENERAL FUNCTIONS Aid in wound healingAid in wound healing Prevent open wound contaminationPrevent open wound contamination Wound debridementWound debridement Maintain moist wound environmentMaintain moist wound environment Support or protect deeper body partsSupport or protect deeper body parts PressurePressure Prevent/reduce swelling or hemorrhagePrevent/reduce swelling or hemorrhage Prevent weight bearingPrevent weight bearing Immobilization of tissuesImmobilization of tissues Often serve multiple functions 10. BANDAGE LAYERS Primary Layer In direct contact with skin or wound Choice of material dictated by Presence / absence of wound Stage of wound healing Amount exudate Necrosis/infection 11. BANDAGE LAYERS Primary Layer Functions: Debridement Deliver medication Transmit exudate to 2nd layer Seal wound 12. BANDAGE LAYERS Secondary Layer Functions: Absorption of wound exudate / fluid Support Compression 13. BANDAGE LAYERS Tertiary Layer Functions: Protects from environment Holds bandage in place Immobilizes 14. BANDAGE LAYERS Tertiary Layer Functions: Protects from environment Holds bandage in place Immobilizes 15. GENERAL PRINCIPLES Improperly placed bandages can be very harmful!!! Too loose will not help; Too tight will harm Avoid circumferential tape When placing bandage, remember: Daily care necessary Weekly change mandatory 16. BANDAGE TYPES Modified Robert Jones*** Robert Jones Splints*** Spica Splint Schroeder - Thomas Splint Casts Ehmer Sling Robinson Sling Velpeau Sling 17. MODIFIED ROBERT JONES Very common bandage Forelimb or hindlimb Numerous indications Protect incision or wound Provide support (minimal) Prevent / reduce swelling 18. MODIFIED ROBERT JONES Tips Always work distal to proximal Maintain constant pressure 50 % overlap Place the limb in functional position Avoid wrinkles Visualization of middle toes 19. MODIFIED ROBERT JONES TipsTips Always work distal to proximalAlways work distal to proximal Maintain constant pressureMaintain constant pressure 50 % overlap50 % overlap Place the limb in functional positionPlace the limb in functional position Avoid wrinklesAvoid wrinkles Visualization of middle toes 20. MODIFIED ROBERT JONES Layers Stirrups 21. MODIFIED ROBERT JONES Layers Stirrups Primary layer (if required) 22. MODIFIED ROBERT JONES Layers Stirrups Primary layer (if required) Cast padding 23. MODIFIED ROBERT JONES Layers Stirrups Primary layer (if required) Cast padding Rolled gauze 24. MODIFIED ROBERT JONES Layers Stirrups Primary layer (if required) Cast padding Rolled gauze 25. MODIFIED ROBERT JONES 26. MODIFIED ROBERT JONES Layers Stirrups Primary layer (if required) Cast padding Rolled gauze Vetrap 27. MODIFIED ROBERT JONES 28. MODIFIED ROBERT JONES TipsTips Always work distal to proximalAlways work distal to proximal Maintain constant pressureMaintain constant pressure 50 % overlap50 % overlap Place the limb in functional positionPlace the limb in functional position Avoid wrinklesAvoid wrinkles Visualization of middle toesVisualization of middle toes 29. ROBERT JONES Indications Distal limb fractures Compression Temporary immobilization and support Not used as much as used to be 30. ROBERT JONES Layers: Primary layer (if needed) Large amounts of roll cotton Rolled gauze applied tightly Vetrap 31. ROBERT JONES 32. ROBERT JONES 33. SPLINTS Preformed Plastic Aluminum Designed to be applied in a specific position on the limb: Forelimb caudal lateral Hindlimb lateral 34. SPLINTS Preformed Plastic Aluminum Designed to be applied in a specific position on the limb: Forelimb caudal lateral Hindlimb lateral 35. SPLINTS Molded Water activated fiberglass Thermolabile plastic Can be perfectly fitted and adapted to specific situation PreformedPreformed PlasticPlastic AluminumAluminum Designed to be applied inDesigned to be applied in a specific position on thea specific position on the limb:limb: ForelimbForelimb caudalcaudal laterallateral HindlimbHindlimb laterallateral 36. MOLDED LATERAL SPLINT 37. SPLINTS Indications Provide additional stability to fracture repair Post carpal / tarsal arthrodesis Support after cast or ESF removal Protect soft tissue repairs of the distal limbs 38. SPLINTS Application Same layers as MRJ: Cast padding Rolled gauze Splint Rolled gauze Vetrap Apply over sufficient padding Too much padding will result in loss of stability 39. SPLINTS Application Splint must extend well beyond area to support Padding must extend beyond splint 40. WHAT IS WRONG WITH THIS SPLINT? 41. WHAT IS WRONG WITH THIS SPLINT? 42. SPICA SPLINT Used for stabilization of the humerus and femur Splint applied laterally extending over the shoulder or hip Not adequate for most fractures 43. SCHROEDER - THOMAS SPLINT Properly applied can maintain traction on distal limb fractures Indications Fractures below the elbow or stifle Immobilization of elbow, carpus, stifle and tarsus 44. SCHROEDER - THOMAS SPLINT 45. CASTS Indications Case selection is of prime importance!!! Rare, non-displaced, simple transverse fractures below elbow or stifle Owner compliance is mandatory!!! Proper care at home Regular examination by veterinarian 46. CASTS Application Cast must extend well beyond the fracture site Layers Stirrups Stockinette Cast padding Rolled gauze Cast material Vetrap May be bivalved: allows for changing 47. CASTS 48. SPECIAL BANDAGES 49. EHMER SLING Used to prevent weight bearing of pelvic limb Results in: Abduction of limb Internal rotation of hip Indications: Post reduction of hip luxation Post acetabular fracture repair 50. EHMER SLING 51. EHMER SLING 52. EHMER SLING 53. ROBINSON SLING Used to prevent weight bearing on hindlimb Allows some range of motion of tarsus and stifle 54. VELPEAU SLING Non-weight bearing sling for the forelimb Indications: Immobilization following shoulder surgery Scapular fractures Following reduction of shoulder luxation 55. BANDAGE CARE Close observation and care is critical Change as often as necessary Keep clean and dry Cover with plastic when outside/Remove plastic inside Monitor for swelling proximal and distal Monitor for foul odor Licking and chewing can indicate a problem HummmHummm This soundsThis sounds like examlike exam materialmaterial 56. BANDAGE CARE Close observation and care is criticalClose observation and care is critical Change as often as necessary Keep clean and dryKeep clean and dry Cover with plastic when outside/Remove plastic insideCover with plastic when outside/Remove plastic inside Monitor for swelling proximal and distalMonitor for swelling proximal and distal Monitor for foul odorMonitor for foul odor Licking and chewing can indicate a problemLicking and chewing can indicate a problem Immediately if:Immediately if: - Strike through- Strike through - Soiled- Soiled - Wet- Wet - Malodorous- Malodorous - Bandage is causing pressure sore- Bandage is causing pressure sore - Vascular compromize- Vascular compromize - Any doubt- Any doubt At least weeklyAt least weekly As often as necessary for woundAs often as necessary for wound carecare 57. BANDAGE CARE Close observation and care is critical Change as often as necessary Keep clean and dry Cover with plastic when outside/Remove plastic inside Monitor for swelling proximal and distal Monitor for foul odor Licking and chewing can indicate a problem 58. COMPLICATIONS Bandaging of a body part can result in: Ineffective treatment Vascular compromiseVascular compromise DermatitisDermatitis Skin and soft tissue necrosisSkin and soft tissue necrosis Loss of range of motionLoss of range of motion 59. COMPLICATIONS 60. COMPLICATIONS Bandaging of a body part can result in: Ineffective treatment Vascular compromise DermatitisDermatitis Skin and soft tissue necrosisSkin and soft tissue necrosis Loss of range of motionLoss of range of motion 61. COMPLICATIONS Bandaging of a body part can result in: Ineffective treatment Vascular compromise Dermatitis Skin and soft tissue necrosisSkin and soft tissue necrosis Loss of range of motionLoss of range of motion 62. COMPLICATIONS 63. COMPLICATIONS Bandaging of a body part can result in: Ineffective treatment Vascular compromise Dermatitis Skin and soft tissue necrosis Loss of range of motionLoss of range of motion 64. COMPLICATIONS 65. COMPLICATIONS 66. COMPLICATIONS 67. COMPLICATIONS Bandaging of a body part can result in: Ineffective treatment Vascular compromise Dermatitis Skin and soft tissue necrosis Loss of range of motion 68. SUMMARY Bandages can be very harmful!!! When placing a bandage, remember: Daily care necessary Weekly change mandatory 69. ADDITIONAL READING Piermattei DL, Flo GL: Handbook of Small Animal Orthopedics and Fracture Repair (ed 3). Philadelphia, PA, Saunders, 1997, pp 49-67 70. QUESTIONS???