The Millpledge Bandage Book PDF
The Millpledge Bandage Book PDF
The Millpledge Bandage Book PDF
Written, Compiled and Edited by Julie Conner VN and Jackie McKerrell VN.
Revised and updated by Meryl Lang, Kim Fergus VN and Heather Roberts VN.
Whilst every precaution has been taken in the preparation of this booklet, Millpledge Ltd do not assume any
responsibility for errors or omissions. Neither is any liability assumed for damages resulting from the use of
the information contained within.
No part of this booklet may be reproduced or transmitted in any form or other means, electronic or
mechanical, including photocopying, recording or otherwise for any purpose except for the practice’s own
use without the express written permission of Millpledge Ltd. Diagrams © Millpledge
Wrapz Bandage
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Experie nce the new high fashion DesignerWrapz
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Superbly flexible and shape conforming.
4
Does not shrink down after application
- No increase in sub-bandage pressure.
E-BAND™
Self-wound cut edge,
full width spread,
porous ventilated
adhesive bandage.
R-BAND™
BANDESIVE™
SW RW Reverse-wound
cut edge, full width
spread, porous
Self or reverse-wound, ventilated adhesive
selve edge elastic adhesive bandage.Yellow
ribbon bandage with red plastic release
guide line. leader tape for easy
start application.
ANISILK™
Artificial silk hypoallergenic tape. Super
soft and conforming with a strong clear
adhesive. High Quality - easily torn
across and down the length.
ANIPORE™
Surgical hypoallergenic paper tape.
Superior Quality. Light and easy to tear.
Permeable and porous. Ideal for holding
needles, giving sets, cannulae, light
dressings, drapes etc. at operation sites.
ANIFILM™
Perforated clear plastic hypoallergenic
tape. Ideal for holding needles, giving sets,
cannulae, light dressings, drapes etc. at
operation sites. High Quality - easily torn
across and down the length.
Translucent
CONTENTS
8 GOLDEN RULES OF BANDAGING
9 REASONS FOR BANDAGING
1 Protection
2 Support
3 Compression
4 Immobilisation
5 Strapping
11 TYPES OF BANDAGE
1 Padding
2 Conforming
3 Non-Conforming
4 Cohesive
5 Adhesive
6 Stockingette
7 Tapes
14 EAR AND HEAD BANDAGES
18 CHEST BANDAGES
20 FOOT AND LOWER LIMB BANDAGES
22 ABDOMINAL BANDAGES
24 TAIL BANDAGES
28 ROBERT JONES BANDAGES
32 VELPEAU SLING
34 EHMER SLING
36 MODIFIED EHMER SLING
38 THOMAS EXTENSION SPLINT
40 ANATOMICAL DIRECTIONS AND SELECTED POINTS OF A
DOG
42 DISCHARGING YOUR BANDAGED PATIENT
44 EQUINE BANDAGING
44 - Pressure Bandaging
45 - The Hock
48 - Leg Bandaging
50 - The Knee
52 - The Foot
54 ANATOMICAL DIRECTIONS AND SELECTED POINTS OF A
HORSE
56 GLOSSARY
57 GLOSSARY AND PREFIXES
7
GOLDEN RULES FOR
BANDAGING
a) Wash hands. Be careful not to spread contamination via hair or wound debris.
Remember also to wash hands thoroughly after finishing the dressing.
b) Collect all materials together, placed within easy reach, including scissors, soapy
wash if needed, new dressings, bandages and other essential equipment.
c) If removing a soiled dressing, dispose of it quickly and safely into a clinical waste
bag, likewise with all cotton wool and swabs used to clean the wound.
d) If bandaging the lower limb, it is advisable to include the foot in the bandage.
This will help prevent swelling. Pressure points and extremities should be padded
out first.
e) If bandaging extremities, start from the distal end to prevent pocketing of blood.
f) Only unroll a small amount of bandage at a time. This will enable a more even
tension to be applied throughout. It will also be easier to handle. Reverse roll
bandage on to the patient wherever possible.
g) Apply bandage firmly, with ½ to ²/3 overlap in a spiral action. Be careful not to
apply too tightly (especially elasticated bandages) as this will impede circulation,
but firmly enough to perform the desired requirement and to ensure that they
will not fall off.
h) Avoid sticking bandages to the animal’s skin or hair except where bandaging tails
for example, where hair may need to be included to hold the bandage on.
j) Where necessary, secure ends of bandage either by splitting and tying in a reef
knot, or adhesive tape. Do not use clips, pins or elastic bands.
k) Choose your bandages carefully. Ensure the correct type for the correct
usage. Similarly, choose an appropriate width. Too wide and the edges may be
cumbersome and could roll over, too narrow and it may cause stringing and
become uncomfortable for the patient. Likewise, it will ease your application if
the correct bandage has been chosen for the appropriate job.
8
REASONS FOR BANDAGING
1 PROTECTION
2 SUPPORT
a) To improve mobility.
b) To reduce pain and swelling.
c) Extra support for internal fixation of fractures.
3 COMPRESSION BANDAGES
POINTS TO REMEMBER
A tourniquet is invaluable in such situations and when used in the correct manner as
previously described. However, an animal who has a tourniquet in place must be under
constant supervision, and at no stage should the tourniquet be covered over with any
type of bandage or dressing.
9
4 IMMOBILISATION
5 STRAPPING
POINTS TO REMEMBER
Do remember whatever your reasons for bandaging each patient, your ultimate goals
must be:-
a) The bandage must serve the purpose for which it was intended.
b) The bandage must be applied firmly, ensuring it has not been applied too tightly
and circulation has not been impaired.
c) It must be as comfortable as possible for the patient.
d) It must look professional - take a pride in its appearance.
10
TYPES OF BANDAGE
1 PADDING
Essential for foot bandages to pad out around the toes, pads, also dew-claws if
present. Cotton wool is ideal, particularly in long strips to go between the toes.
Do remember, cotton wool is a natural fibre and will absorb fluid, particularly
from sweaty feet and may become quite solid. It is therefore essential to change
foot dressings quite regularly to prevent any sores. Extra padding is also advisable
around pressure points, such as the elbow and hock on limb bandages.
Another form of padding available is cotton wadding (a layer of cotton wool
sandwiched between two layers of gauze). These are ideal for use as, or in
conjunction with poultices or compresses. Cotton wool should not be applied
directly to a wound, due to the nature of the product you will undoubtedly leave
cotton fibres in the wound. If cotton wool is used on top of an appropriate wound
dressing, it is likely to prevent the wound from being dressed too tightly and will
absorb any excess exudate from the wound. Synthetic padding on a roll is ideal
for undercast protection for ease of application, particularly as it will reduce
moisture absorption from the cast. Another advantage of this type of padding, is
that it is of even consistency and thickness throughout the roll, thus giving the
finished bandage a more even surface overall.
Suggested Padding:
Millpledge Padding Materials: Orthoband™, Cotton Wool (Vet, BP, HQ),
Millsoft™, Ortho-Wool™, Zorbopad™, Zorbo-G-Padding, Poultex®.
2 CONFORMING
A true conforming bandage is one that can be stretched to maximum, released
and then remain in much the same condition as the original bandage, without
allowing holes to be poked through it.
Conforming bandages have revolutionised bandaging, due to their ability to
contour easily allowing essential movement. There are many different types and
weights available, depending on the degree of support required. Conforming
bandages do however have some content of elastic, so it is essential not to apply
too tightly, as this may interfere with circulation. Do remember, if sufficient
padding has been applied, it should eliminate the possibility of bandaging too
tightly and will be well tolerated by the patient.
11
3 NON CONFORMING
Usually cotton bandages, and as the name suggests, there is no widthways or
lengthways expansion. Consequently they will not conform to the animals’
contours, without accurately placed twists and turns, to enable the bandage to
fit snugly. For these reasons, non-conforming bandages are rarely used today,
apart from holding endo-tracheal (ET) Tubes in place, holding the doors open
in hot weather, muzzling stroppy dogs’ noses, holding Veterinary Surgeons’ gowns
together and other similar essential uses.
4 COHESIVE
These are usually of a conforming nature, very easy to use and covered in a thin
layer of latex which enables it to cling to itself, but not to the animals’ skin or
hair. Cohesives are air permeable, soft and easy to apply even to the most fidgety
patient (if you let go at any stage, the bandage will remain in place and not
unravel). This type of bandage is comfortable for the animal as it does not pull on
hair, therefore the patient is less likely to interfere with the bandage. Due to their
ease of use, cohesives are more comfortable and convenient to remove when the
time comes.
The majority of cohesives are ideal for top bandages. They come in bright colours
which can be used as a coding system if the patient needs re-bandaging, e.g. red
- for immediately post operative, blue - for a first redress and white - for a second
redress. This is particularly useful in larger practices, where more than one
Veterinary Surgeon will examine the patient.
5 ADHESIVE
Not used quite so much now due to the convenience of cohesives. As the name
suggests they are covered with a layer of adhesive, which is useful to hold on
awkwardly positioned bandages. This is very much down to the individual choice
of the Veterinary Surgeon or Veterinary Nurse. Adhesive bandages may be used
as a top covering, to improve durability, but do remember it will be harder to
remove. Some adhesive bandages come with a line down the centre, this is to
enable you to ensure an even ½ overlap on application.
12
6 STOCKINGETTE
These are tubular, elasticated, usually cotton composition bandages which come
on a long roll. They can be ‘net like’ in appearance and available in various
different sizes. Very useful for body bandages and to hold dressing pads in
awkward places, e.g. chest, mid line dressings (post operatively). Use a suitable
size, pulling over patient’s body, cutting holes for patient’s legs as necessary. A
metal tubular applicator may be used to apply such bandages to limbs, but care
does need to be taken to ensure adequate twisting while applying, or the whole
bandage will slip down the limb. Stockingette bandages used on extremities will
usually need a top bandage for extra protection.
7 TAPES
Quite a variety available from non stretch zinc oxide style, to hypoallergenic
tapes. Some tear easily and are relatively transparent, ideal for holding I.V
cannulae in place. Occasionally used for a temporary bandage, e.g. immediately
post dew-claw removal, but would be taken off before the patient is discharged.
Care needs to be taken when using spirit at site of tape application, as any type
of spirit is likely to lift adhesive from the various tapes and leave a sticky mess on
the patient - doesn’t make for a happy owner!
Anifilm is ideal for using on birds’ wings as it will hold securely, but will enable
regular inspection to take place and is unlikely to harm feathers on removal.
Likewise, Zinc Oxide (A-Tape) is ideal for using for Robert Jones ‘stirrups’.
Suggested tapes:
Millpledge Tapes: A-Tape (Zinc Oxide), Anifilm™, Anipore™, Anisilk™,
W-Tape™.
13
EAR & HEAD BANDAGES
14
EAR & HEAD BANDAGES
A head bandage may be used to secure one or both ears on top of the head. This
may be used following aural resection, either single or bilateral. Another use might
be after an aural haematoma has been corrected, by bandaging the treated ear to
the head, it will help prevent re-occurrence of the haematoma. The animal may just
be suffering from a severe case of Otitis Externa, in which ventilation is essential so
putting both pinnae up on top of the head, the ear canals are held open which is
ideal for ventilation and treatment.
A good way of placing the pinnae in the correct manner and position, is to pick
up each pinna by the tip, using thumb and index finger, then with a sweeping
movement, gently placing pinna on central cranium thus finding the most
comfortable, natural and best tolerated position.
Fig 1. For an ear bandage, place padding on the top of cranium point 1, fold pinna
‘A’ over padding by method previously described, then place more padding e.g. a
gauze swab or bandage on top of pinna ‘A’. Fold pinna ‘B’ on top of pad. Tape pinnae
together with an adhesive tape or bandage to prevent slipping.
Fig 2. For a head bandage an alternative would be to use the ‘figure of eight’ method.
One or both pinnae may be included in this bandage. If leaving out one pinna, it
will provide a good anchorage point for the bandage. (See figure 3 overleaf). Place
padding on top of the cranium point 1, fold over pinna ‘A’, followed by further
padding and pinna ‘B’, if being included. Padding will then be required around the
patient’s neck. Take an appropriate conforming bandage, starting at the centre of the
cranium point 1, then roll bandage forward to cover the cheek bone, rostral to left
pinna point 2, then under chin to opposite cheek bone, rostral to right pinna point 3.
Then take the bandage diagonally across the centre of the cranium point 1 to point
4, caudal to left pinna, under neck to point 5, caudal to right pinna, then back to the
starting point 1.
For ease of application we have numbered the significant points on the diagram as
follows:
1 Central Cranium
2 Rostral to left pinna
3 Rostral to right pinna
4 Caudal to left pinna
5 Caudal to right pinna
To simplify applying head bandage from the start follow the sequence:
1-2-3-4-5-1
repeating in decreasing figures of 8 until desired covering is acquired. See figure 4
overleaf.
15
EAR & HEAD BANDAGES
16
EAR & HEAD BANDAGES
continued
Cohesives are ideal for this type of bandage not only due to their lightweight and
porous properties, but also as they are comfortable and well tolerated by the patient
and due to their cohesive properties, they tend to stay in situ.
Ensure bandage is put on firmly but not too tightly, as this may lead to dyspnoea, so
check regularly.
Suggested materials:
Wound Dressings:
Millpledge Dressings:
Zorbopad™, Mill Swabs, Grassolind, LP Dressing Pads, Poultex®.
Padding Layer:
Millpledge Padding:
Orthoband™.
Conforming Layer:
Millpledge Bandages:
Knit-Fix™, Knit-Firm™, Co-Form™, Co-Lastic™.
Top Layer:
Millpledge Bandages:
Co-Ripwrap™, Wrapz™.
17
CHEST BANDAGES
18
CHEST BANDAGES
Used quite commonly mainly holding dressings in place around the chest or shoulder
region, or for holding chest drains securely following surgery. Select and apply
sufficient and appropriate padding. Choose an appropriate width conforming or
cohesive bandage. Start your bandage at the withers point 4; take bandage down
to point 1, through the fore legs point 2 and around the left axilla point 3, up over
shoulder point 4, down over opposite axilla point 5, through under sternum (in a
cranial direction) point 2, up over to point 4, returning down to right axilla point 5,
under the chest to point 3 returning to point 4. See figure 1.
To simplify the application of the bandage, we have labelled the diagram with the
following points:
1 Right shoulder
2 Sternum
3 Left Axilla
4 Top of shoulder
5 Right Axilla
Do note that this type of bandage will not provide as much support, compared with
the chest bandage previously described, but is ideal for holding dressings or chest
drains in place.
Suggested materials:
Chest Bandage:
Millpledge Bandages:
Knit-Fix™, Knit-Firm™, Co-Form™, Co-Lastic™, Wrapz™.
Stockingette
19
FOOT & LOWER LIMB BANDAGES
20
FOOT & LOWER LIMB BANDAGES
Where possible it is advisable to include the foot in lower limb bandages to prevent
oedema.
fig 1 and 2) Cut nails if necessary and pad out toes, including stopper pad and dew-
claws if present. Pad between the toes extending to metatarsal/metacarpal
region. Adequate padding will ensure the toes do not rub together as this may
cause unnecessary swelling and sweating, possibly leading to excoriation.
fig 3) Apply further padding. Commencing at the top of point 1, roll your padding
material longitudinally down the dorsal aspect of the limb to foot, under pads,
then up palmar/plantar aspect, to top of point 2. Reverse procedure to return
to starting position at point 1. It may be advisable to anchor bandage at this
point around 1-2-1, then roll diagonally to point 3, around in palmar/plantar
direction to point 4. Then spiral padding from distal end of foot using ½ to ²/3
overlap up to the proximal end of padding.
fig 4) Conforming Bandage Layer : Apply as figure 3. Secure ends of bandage with a
tape, reef knot, or tuck in loose end.
fig 5) Due to the area bandaged, it is advisable to use a top covering of a suitable
material to act as further protection for the bandage. A cohesive is ideal,
although you may prefer to use an adhesive bandage. Either way it is advisable
to place a strip of your cohesive/adhesive bandage over the distal end of the
conforming layer, giving extra protection to the pads and at the same time
helping the durability of the bandage.
After applying extra protection over the distal end of the conforming layer,
apply third layer in a spiral motion from distal to proximal ensuring end of
bandage finishes at palmar/plantar aspect
NB: A ring doughnut made of cotton wool may be useful, over dew claws or other
protrusions, as an alternative style of padding.
Suggested materials:
Padding:
Orthoband™, Cotton Wool (Vet, BP, HQ), Millsoft™, Orthowool™.
Conforming Layer:
Knit-Fix™, Knit-Firm™, Co-Form™, Co-Lastic™.
Third Layer:
Wrapz™, Co-Ripwrap™, Bandesive™, E-Band™, R-Band™.
21
ABDOMINAL BANDAGE
22
ABDOMINAL BANDAGE
This type of bandage is not used too widely. Depending on the shape of the patient
and also the breed, it can be very difficult to apply, let alone keep in place. It is useful
to use an abdominal bandage to hold a dressing in place after a mid-line operation, to
help prevent haemorrhage, or just as an absorbent layer for a weeping wound.
With abdominal bandages, apart from rolling in, there is also a tendency for them
to slip. It is therefore a good idea to use a cohesive bandage, with a strip of adhesive
tape at each end to anchor it down. Alternatively, take bandage around shoulders
and/or sternum to prevent bandage slipping.
Remember to keep the animal’s comfort in mind, use wider bandages, and do not
apply too tightly, as this may interfere with its breathing.
Alternatively you may use a stockingette bandage pulled over the animal’s body
with appropriate holes cut in for the limbs. Also make sure male dogs can urinate
unhindered.
Suggested materials:
Dressings:
Poultex®, Zorbopad™.
Padding:
Orthoband™
Conforming Layer:
Wider widths of Knit-Fix™, Knit-Firm™, Co-Form™, Co-Lastic™.
23
TAIL BANDAGES
24
TAIL BANDAGE
with plastic cover
An awkward bandage to apply, but very useful if the end of the tail is damaged
- easily done in long tailed breeds, or even if the tip has had to be amputated.
Another reason to bandage the tail, may be to protect the tail from post operative
contamination of anal furunculosis, or other surgery around the animal’s rear end.
Due to the shape and proximity of the tail to the body, it will always be difficult to
keep the bandage on - particularly on happy dogs who may ‘wag’ your bandage off as
soon as the owner appears! Don’t despair, persevere!
There are two commonly used methods of bandaging tails. One is to use a plastic
syringe case, particularly useful if covering a short and stumpy tail. The other is by
spiral binding of the tail.
Firstly ensure syringe case is clean, then either pierce or cut away the end of the case
for good ventilation. Dress the tail as appropriate to the wound.
Fix the case to the tail by enclosing some tail hair with each revolution of the
bandage from the case proximally, to the base of the tail, point A to B as on Fig 1.
This is one occasion in which it will be necessary to use an adhesive tape directly on
to the animal’s hair at proximal end of the syringe case.
Suggested Materials :
Wound Dressings:
Zorbopad™, Grassolind™, Zn7™ Wound Healing Gel.
Conforming Layer:
Knit-Fix™, Knit-Firm™, Co-Lastic™, Co-Form™, VetBand™.
Strapping Tapes:
E-Band™ 2.5cm.
25
TAIL BANDAGES
26
TAIL BANDAGE
Fig 2) Use a conforming bandage to roll from dorsal base of tail point 1, to tip of tail
point 2, returning on the underside to ventral base of tail point 3, back to tip point 2.
Fig 3) Spiral bandage from point 2 in a proximal direction ensuring ½ to ²/3 overlap
to base of tail points 1 and 3, ensuring even pressure is applied. It may be useful to
enclose some tail hair with each revolution, as you near the base of the tail. Secure
the ends of the bandage, with reef knot or tape. It may be necessary to use adhesive
strapping tape to complete the last steps of attaching bandage to tail hair at base.
Fig 4) For long tailed dogs a ‘tail hobble’ may be of use. This is made from tape
around a stifle, and enough length to allow the animal to defecate, but not long
enough to wag the tail. It is then secured around the tail and back to the stifle.
Ensure sufficient padding is applied, to the area above the hock, to prevent slipping.
NB. Check daily to ensure the tape is comfortable and not causing any swelling,
irritation, or any other problems.
Suggested Materials
Dressing:
Zorbopad™, Grassolind™, Zn7™ Wound Healing Gel.
Padding:
Orthoband™, Millsoft™, Cotton Wool (HQ, BP, Vet).
Conforming layer:
Knit-Fix™, Knit-Firm™, Co-Form™, Co-Lastic™, VetBand™.
Third Layer:
Wrapz™, Co-Ripwrap™, E-Band™, Bandesive™, R-Band™.
Hobble:
Wrapz™ 2.5cm, E-Band™ 2.5cm
27
ROBERT JONES BANDAGE
28
ROBERT JONES BANDAGE
This bandage is very widely used but it may take a bit of practice to get it just right:
Persevere! Here the two most commonly used methods are described, although there
will be several variations of the Robert Jones Bandage, but the one thing in common
is that the composition is of several layers bound together firmly, to produce the
same neat, cylindrical bandage, providing maximum support and pain reduction.
It may be used on fore and hind limbs. Robert Jones is also used for support and/or
immobilisation pre and post operatively for traumatic fractures, with or without soft
tissue damage.
Apart from restricting limb movement, it can also help reduce and/or prevent
oedema, and the possibility of haematomas forming, merely due to the even pressure
applied to the whole limb.
Another indication of where the Robert Jones bandage may be useful, is where a
tumour has been excised either near or over a joint. Likewise if you have general
lacerations, abrasions or even injuries following a road accident, after appropriate
wound dressings have been applied. Although this will look like a very bulky
bandage, it is relatively lightweight and although applied firmly, it is superb
cushioning for traumatised soft tissue, and most importantly, is usually very well
tolerated by the patient.
Method 1:
1 Dress any open wounds as appropriate, pad out toes, including stopper pad and
dew-claws if present, then cut two lengths of zinc oxide tape to cover at least 15
- 20cm (6 - 8 inches) up the leg and 10 - 12 cm (4 - 5 inches) overlap at the toes.
Stick these to the anterior and posterior aspects of the leg respectively, ensuring
coverage over and above metatarsal/metacarpal region. Stick loose ends together for
the time being to prevent them sticking to anything else! These are known as the
‘stirrups’. See figure 1.
2 Pad out toes as necessary. Carefully unroll the end of a complete roll of cotton
wool. Position roll over leg to start ½ way up the toe nail - reverse roll cotton wool
spirally up to proximal end of leg. (Narrow rolls of cotton wool are available for short
legged dogs, called Ortho-Wool). Wrap the cotton wool around the leg at least 4 - 5
times as firmly as is possible. See figure 2.
NB: A 500g roll should be sufficient for a large dog’s legs.
30
ROBERT JONES BANDAGE
continued
4 Unstick free ends of zinc oxide tape and fold back securing to cotton wool bound
layer. These stirrups prevent the whole bandage from sliding down the animal’s limb
and are one of the few occasions where it is essential to stick something directly to
the hair. The stirrups are then further secured by the top covering. An appropriate
width cohesive bandage is ideal for this layer, working in the usual spiral action with
½ to ²/3 overlap starting at the distal end and working proximally. Alternatively an
adhesive bandage may be used if preferred.
The end result is a bandage approximately 3 times the width of the dog’s leg, and
should make a sound like a ripe water melon when flicked. See figure 3 for the
composition of the completed Robert Jones bandage.
The importance of leaving the two middle toe nails exposed is twofold: Firstly to
enable the animal to balance and secondly to allow regular checking of the animal’s
circulation (which is easier in white nailed dogs) and its temperature. Extremes in
temperature (too hot/cold) may also indicate possible infection, or bandage on too
tightly.
Method 2:
A variation of this method is to use alternate layers of cotton wool and conforming
bandage followed by another layer of cotton wool and another layer of conforming
bandage, repeated to give at least three layers of each. The remainder of the bandage
would be applied the same as described in the previous method.
The successful result should still produce a plain cylindrical bandage with a resonant
sound heard when the bandage is flicked.
Suggested materials:
For stirrups:
A-Tape™ (zinc oxide)
Padding:
Cotton Wool (Vet, BP, HQ), Millsoft™, Orthowool™, Cotton Gauze Wadding,
Orthoband™.
Conforming Layer:
Knit-Fix™, Knit-Firm™, Co-Lastic™, Co-Form™.
Third Layer:
Wrapz™, Bandesive™, R-Band™, E-Band™.
31
VELPEAU SLING
32
VELPEAU SLING
This bandage is used specifically to immobilise the shoulder, usually as the treatment
following reduction of shoulder dislocation. Although the bandage performs this task
very efficiently, care must be taken when using it particularly on larger breeds, or just
older dogs. The reason for this being that the restriction may cause difficulty in free
movement. If the dog has arthritic joints or pain in other such joints, he is therefore
less likely to move about to urinate, eat or perform other functions, thus slowing
recovery.
Pad out foot as necessary with cotton wool. Using a conforming bandage, secure
ends to a pre padded metacarpal region. Take bandage from lateral to medial
direction points 2 to 1 over the palmar aspect of paw. Flex carpus, elbow and
shoulder to maximum. Bring bandage up over lateral paw, limb and lateral aspect of
shoulder, point 3, then down to opposite axilla point 4, and back under the chest to
points 1 and 2. Repeat from steps 2, 3, 4 taking bandage dorsally around point 5
over lateral aspect of shoulder to point 3. See figure 1.
For ease of application we have numbered the significant points of the diagram as
follows:
1 Medial Metacarpal
2 Lateral Metacarpal
3 Anterior Aspect of Shoulder
4 Opposite Axilla
5 Knee Joint
To simplify the steps on how to apply the velpeau sling from the start, follow this
sequence:
2-1-2 * 3 - 4 - 5 - 3 - 4 - 2.
Repeat from asterisk * until sufficient support for immobilisation of the elbow, thus
preventing any extension of this joint. See figure 2.
For neatness and a firm support, the whole bandage can then be covered by an
appropriate cohesive or adhesive bandage as preferred.
POINTS TO REMEMBER :
Do not use a ‘figure of eight’ in the construction of this type of bandage. There
should be no bandage in front of opposite shoulder, all revolutions pass back under
opposite axilla at point 4, See Fig 3.
Suggested materials:
33
EHMER SLING
34
EHMER SLING
The Ehmer Sling is used for immobilisation of the hip joint, usually for support
post reduction of a hip dislocation, where the femoral head has luxated from the
acetabulum. Likewise it may be used to prevent weight bearing on a hind limb. The
ultimate aim however, is the same for both variations i.e. the foot slightly rotated
inwards, the hock outwards, thus forcing the femoral head back into the acetabulum,
with the leg held in extreme flexion.
The shape and size of the animal must be taken into consideration when using this
bandage, particularly if the animal is either obese or heavily muscled, as this may
cause the bandage to slip. Also if the animal is old or has arthritic joints, this may
cause difficulty in flexing the patient’s affected limb comfortably, making it less likely
to move about, eat, urinate or perform other functions, thus slowing recovery.
Secure bandage around pre padded metatarsal area leaving toes exposed if preferred.
Using a conforming bandage, take it from Medial Metatarsal around the lateral
aspect of metatarsal point 1, up the medial aspect of the stifle point 3. The area over
the femur is then padded and the bandage brought over the lateral aspect of the
thigh, point 4, returning to point 1. See figure 1.
For ease of application we have numbered the significant points on the diagram as
follows:
1 Lateral Metatarsal
2 Medial Metatarsal
3 Medial Stifle-Anterior
4 Lateral Thigh Femur
Therefore to simplify the steps needed to be taken to apply the bandage from the
start is as follows:
2 - 1 - 2 - 3 - 4 to hold foot in slight inward rotation, to be followed by point
1 - 2 - 3 - 4 Repeat sequentially, until sufficient support is acquired. Secure end.
See figure 2.
A final top covering of cohesive bandage may be used to help protect the underlying
conforming bandage and provide extra support whilst remaining lightweight and
porous. If preferred, adhesive bandages may be used in place of a cohesive, but they
may be more difficult to remove.
Suggested materials:
Padding and strips: Orthoband™, Cotton Wool (Vet, BP, HQ), Millsoft™,
Cotton Wadding, OrthoWool™.
35
MODIFIED EHMER SLING
36
MODIFIED EHMER SLING
As the name suggests, this bandage is a modified variation of the afore mentioned
Ehmer Sling. This may also be described as the ‘Figure of Eight’ bandage or even the
‘Butterfly’ bandage. The ultimate aim however, is the same for both variations i.e.
the foot slightly rotated inwards, the hock outwards, thus forcing the femoral head
back into the acetabulum, with the leg held in extreme flexion.
POINTS TO REMEMBER:
You may find it necessary between points 4 and 5 and points 2 and 3, to rotate your
bandage through 180º to ease application and fit more comfortably.
1 Lateral Metatarsal
2 Medial Metatarsal
3 Medial Stifle-Anterior Femur
4 Lateral Thigh
5 Medial Hock
Therefore to simplify the steps needed to be taken to apply this bandage from the
start are as follows:-
1 - 2 - 3 - 4 - 5 followed by:- * 2 - 1 - 3 - 4 - 5
Repeated in this order from the * until sufficient support is acquired. Secure ends.
A final top covering of cohesive bandage may be used to help protect the underlying
conforming bandage and provide extra support whilst remaining lightweight and
porous.
Suggested materials:
Padding and strips: Orthoband™, Cotton Wool (Vet, BP, HQ), Millsoft™,
Cotton Wadding, OrthoWool™.
37
THOMAS EXTENSION SPLINT
38
THOMAS EXTENSION SPLINT
A great deal of practice is needed to master the skill of applying a Thomas Extension
splint, but it is very useful for fractures of the fore or hind limbs, where other means
of support are impractical. The Thomas Extension splint may be left in situ for up to
six weeks, but the leg should be checked for sores frequently and the animal rested
as much as possible. You should be aware that the animal may have difficulty in
manoeuvring, especially trying to stand, from a lateral position.
The second distance to be measured, is from the extended toe, point 3, then around
the loose perimeter of the animal’s leg, via points 4, 5, 1, 2 and back to 3 on figure 1.
The aluminium is cut to this length, then padded with cotton wool, or another such
suitable material, to protect the leg from pressure sores, and to act as a cushion from
any external forces. Join ends together, shaping scaffold support to make a splint
around the circumference of the limb - as in figure 1.
The horizontal crutch should then be joined to the main splint at the correct height
(as previously measured) on the medial aspect - point 1 in figure 1.
Any wounds should be suitably dressed, then ‘stirrups’ applied to the distal end of
splint at point 3, having first been attached to the toes, point 6.
The ‘stirrups’ are used to extend the toes, and by fixing them to point 3, it will ensure
stability without excess movement. A cohesive covering is then applied to cover
the lower splint, and prevent lateral to medial movement of the limb, see figure 2.
Adhesive bandages may be used if preferred, but may cause discomfort to the animal
where it comes into contact with the animal’s hair. By only partially covering the
splint, good ventilation of the leg is ensured.
Suitable materials:
39
40
ANATOMICAL DIRECTIONS AND
SELECTED POINTS OF A DOG
41
POINTS TO REMEMBER ON
DISCHARGING YOUR PATIENT
a) Ensure the owner has a follow up appointment to change or remove the bandage.
b) Ask the owner to keep the bandage as clean and dry as possible. When walking
out of doors, it is advisable for foot bandages to be temporarily covered with a
plastic bag held on with tape, not pins or elastic bands. Dog and cat boots are
commercially available for this purpose. Alternatively, if you have a used fluid bag
available, cut off the injection ports end, wash and dry thoroughly and then make
several holes around the top. Thread either Vet-Band or Knit-Firm through the
holes (see the diagrams).
This enables the tape ends to be pulled in a purse string manner and neatly tied
for quick and easy application and removal by the owner. These bags are ideal,
due to the strength and thickness of the plastic. Instruct the owner on how to
apply the bag and also to remove immediately on returning after the walk. This
is to prevent unnecessary sweating of the foot.
c) Ask owner to look out for any swelling, discharge, pain or unpleasant smell from
around the bandage. Insist on reporting back to the surgery immediately if in any
doubt.
d) If necessary, provide help and advice to prevent animal interfering with its
bandage, such as using a bitter spray or an Elizabethan Collar or bucket around
the head. Do impress on owners that the animal may need to be supervised whilst
initially wearing such protection.
e) If patient requires complete rest and isn’t too co-operative, e.g. a boisterous
puppy, it may be necessary to use mild tranquillisers such as ACP. This must, of
course, be done under the Veterinary Surgeon’s strict directions of dosage and
length of treatment, and must be carefully explained to the owner.
f) Finally, listen to the owner. Answer their varied and many questions, and reassure
them they can telephone any time for advice, or return the animal to the surgery
if they are at all concerned.
42
AND FINALLY…
don’t forget to check
That the finished bandage is neat - no loose ends where the patient may be able to
claw, chew or pull undone.
That the bandage is sufficient for the purpose for which it was intended; e.g. if for
immobilisation of a limb, that the animal cannot actually bend that limb.
That your patient is as comfortable as possible. This will aid a speedy recovery if the
patient can continue with as much normality as possible.
That it appears professional. It is very embarrassing when the patient gets home and
shakes off your prized bandage!
That the bandage is applied firmly but not too tightly. Check for dyspnoea, having
applied head, neck, chest or abdominal bandages.
Bandaging techniques
continue overleaf within the
equine section
43
EQUINE BANDAGING
Pressure Bandages
It may on occasions be necessary to apply an emergency pressure bandage until
veterinary care can be sought. This may be done to serve a number of purposes,
including:
· To stem or control bleeding.
· To stabilise the limb, suspecting damage to bone, tendon or ligament.
· To minimise swelling.
· To protect a wound from further trauma or contamination.
A pressure bandage by its own nature has real potential to cause harm to the
limb, and as such should be applied carefully, with subsequent attention paid to
the horse.
If cleansing is appropriate and not likely to cause further damage, cold water
should be used to rinse the area. The cold water will assist in vasoconstriction, thus
minimising blood flow as far as possible. Prolonged rinsing should be avoided. Sterile
saline solution is preferable, but tap water is adequate, and realistically more readily
available in an emergency. In some instances, it may be appropriate to apply an ice
pack before bandaging.
If an open wound is present, a dressing pad should be applied. Avoid placing cotton
wool onto the wound. Adequate padding material should then be applied, with even
pressure around the limb, to 5cm (2 inches) thick. It is important to use a bandage
with sufficient width – at least 7.5cm but preferably 10cm wide in order to avoid the
bandage from creating a tourniquet effect.
General guidelines:
44
EQUINE BANDAGING
The Hock
The hock is vulnerable to trauma, fatigue and stress. Bandaging may be
recommended following surgery, to protect a wound, or to reduce oedema or heat.
The hock is a difficult site to bandage due to the range of movement and the
resentment the horse feels when this is restricted. The major ‘danger areas’ are the
common calcanean tendon (Achilles tendon) region, and the dorsal aspect of the
hock below the tarsometatarsal joint. The point of the hock is also potential danger
point because of the thin skin cover and prominent bone of the tuber calices.
Along with correct application, dressings applied to the hock rely on the common
calcanean tendon to keep them up. There are serious risks if the bandage is placed
too tight and if it is too loose it will slip.
Wounds on the point of the hock are particularly difficult to dress. A suitable
shaped dressing (e.g. Poultex®) is a useful aid, and can provide an excellent method
of applying a primary dressing to these wounds. The dressing will usually remain in
situ so long as the secondary conforming dressing is suitably supportive.
After the bandage is applied many horses will flex the hock strongly and repeatedly.
During forced extension the forces are transferred to the dorsal aspect of the hock.
If this occurs, the bandage must be checked again for tension over the calcanean
tendon region, and entirely replaced if necessary.
The risks can be minimised by ensuring that a purpose-made soft pad, or a plug
of cotton wool protects the point of the hock. A sympathetic figure-of-eight
bandaging technique is generally used, and there should be no tension on the
common calcanean tendon (a finger should be able to run over the tendon under
the bandage at each stage). This can be supported by including a roll of 10cm (4
inches) wide cotton bandage (unopened) on either side in the hollow below the
common calcanean tendon after the primary and secondary bandages have been
applied. This transfers the tension to the bandage roll. If the bandages are left
sealed, they can be used at the next bandage change!
Regular checks on the comfort and stability of the bandage should be made.
If the dressing is obviously uncomfortable then it should be removed and replaced.
continued…
45
EQUINE BANDAGING - The Hock
1. Lateral View
Apply primary dressing such as
Zorbopad™ or Poultex ® depending
on wound being on either A or B.
2. Dorsal View
Wrap secondary dressing
such as Orthoband™
starting proximally,
continuing into a figure of
eight.
46
EQUINE BANDAGING
The Hock
continued
Applying a hock bandage:
· Pad to at least 5cm (2 inches) thick, and the padding layer should extend at least
12½cm (5 inches) above and below the point of hock.
· Using a figure of eight pattern, begin just below the point of hock. Wind from the
medial aspect around the back of the hock to the lateral aspect then follow on,
extending down medial to lateral (figure of eight).
· Begin applying the supporting bandage below the point of the hock, wrap front
to back, lateral to medial, spiralling upwards, overlapping at 50% of the bandage
width.
· Repeat the figure-of-eight until the bandage extends 10-15cm (4-6 inches) above
the point of hock, 1½cm (½ inch) from the edge of the padding layer.
· Secure the bandage at the top and bottom with an adhesive tape.
ADDITIONAL CONSIDERATIONS:
Horses with hock bandages should be confined at rest unless specified otherwise by
the veterinary surgeon. The bandage should be checked two to three times a day,
with attention paid to any increase in lameness or oedema. In addition, should the
bandage become wet or soiled, it should be replaced immediately.
47
EQUINE BANDAGING - Leg Bandages To put a support bandage on the lower limb of a horse, follow these steps.
Ensure you do not over tighten the bandage during application.
1. Cover any wound with a non stick 2. Apply Orthoband™ to hold the dressing
dressing such as Zorbopad™. in place. Begin on the side of the limb and
wrap the bandage around the leg, before
spiralling down over the dressing and
back up to the starting point.
The pressure
should be light
and even.
Place additional
padding here if the
pastern is to be
included.
3. Apply cotton gauze 4. Use E-band™ or Wrapz™ as the 5. The pressure should
wadding or cotton wool support bandage. Apply in the be firm enough to
twice around the leg. This same direction as the overlap of provide support
padding must extend from the padding. Start halfway down without restricting
just below the knee or hock the cannon bone, placing the end blood supply. Secure
to the fetlock. (Fig 3). of the bandage under the flap of in position with
the padding. (Fig 4) Spiral once tape (fig 5).
around the limb, work down to
the fetlock, then back up to just
below the knee or hock and finally
down to the starting point.
48
EQUINE BANDAGING
Leg Bandages
There are a number of reasons when a horse’s leg may need to be bandaged. They include
protection and support while:
· Travelling.
· Working; supports tendons and ligaments during strenuous exercise.
· Recovering from injury.
· Resting; reduces likelihood of oedema after exercise.
Leg bandages also protect open wounds from contamination thus speeding the healing process.
It is important that correct bandaging techniques are used regardless of the intent for which is
required. Indeed, it is preferable to leave the horse without a bandage than one that has been
ineffectively applied. Bandages that are applied improperly may not do their job but more
seriously, may cause discomfort, impede circulation and have the potential to damage soft tissue
and tendons.
CAUTIONS
Fitted correctly, bandages should cause no permanent damage.
· Sufficient padding material should be used.
· Even pressure must be applied throughout, on both tertiary and intermediate layers.
· No wrinkles, creases or folds should be allowed to form during application.
· The bandage should be securely fastened on the lateral aspect of the leg.
· When removing bandages, the leg should be rubbed to stimulate blood flow.
Bandages that have been applied too tightly may result in the following anomalies:
· Hair loss at the point of contact.
· White hair growth at the point of contact.
· The cannon bone may become inflamed or bruised.
· Secondary injury of tendons at the pressure point may occur.
Applying a leg bandage
· Ensure legs are clean and dry.
· Ensure bandage materials are clean and dry.
· Ensure any open wounds have been dressed according to the surgeons instructions.
· Use at least a thickness of 1 inch of padding, more if indicated.
· Ensure the bandage is applied flat and free from wrinkles.
· Do not begin to bandage over a joint as movement will encourage it to loosen and
potentially unwrap. It is best to start on the medial aspect of the cannon bone, anterior
to the fetlock.
· To maintain the correct alignment and weight bearing force, wrap from front to back,
outside to inside, working in a spiral downwards then back up again. This means
wrapping the bandage in the direction that pulls the flexor tendons towards the lateral
aspect of the limb. (Anti-clockwise on the nearside, counter-clockwise on the offside).
· Ensure consistent pressure applied throughout, avoiding bumps and ridges.
· Ensure the coronet band is covered to protect this area.
· Leave 1½cm (½ inch) padding visible at both the top and bottom of the bandage.
· Check the pressure of the bandage by making sure two fingers can be slipped down
between the bandage and the leg.
· If applied for exercise, bandages should be removed immediately on cessation of work.
49
EQUINE BANDAGING - The Knee
Dorsal View 1. Primary Dressing
Apply primary dressing such as Zorbopad™
or Poultex® over wound.
2. Secondary Dressing
Use Orthoband™ as a secondary
dressing to hold primary dressing in
place.
Continue secondary dressing in figure of
eight. Avoid bandaging over accessory
carpal bone. (See figure 5).
Palmar View
3. Wrap around knee
with cotton wool.
4. Bandage Wrapz™ over top of Remove a plug of
cotton wool, moving distally, cotton wool over
then in a figure of eight. accessory carpal
bone.
Dorsal View
50
EQUINE BANDAGING
The Knee
Being a high motion joint, the knee is difficult to bandage because of the downwards
taper of the area, although the knee itself is wider than the radius and the
metacarpus. Fortunately, horses tolerate immobilisation of this area rather better
than the hock.
The skin over the palmar aspect is particularly thin and skin covering the accessory
carpal bone comes under considerable pressure during flexion and extension of the
carpus. The skin over the medial and lateral radial tuberosities is also thin and very
closely related to the bone: it is very liable to pressure damage from bandages and
therefore extreme care should be taken to sufficiently protect this area.
General guidelines
The dressing is applied using a figure-of-eight format. After the primary layer has
been applied to the wound site it is retained by the secondary layer of a soft cotton
wool bandage, also applied in a figure-of-eight pattern. It is common practice at this
stage to avoid covering the accessory carpal bone.
A layer of cotton wool is placed over the secondary layer in the same format (but
covering the accessory carpal bone), and a plug of cotton wool is removed from over
the bony prominence. A conforming bandage is now applied in the same figure-of-
eight, avoiding the accessory carpal region. The next layer of cotton wool is applied
in a simple overlapping way to cover the whole area, and a cotton bandage and an
elasticated adhesive layer covers this finally.
In order to avoid slippage, it may be helpful to apply a bandage to the lower limb
region first and then dress the carpus. A properly applied carpal bandage will
probably not slip provided that the horse is box-rested.
51
EQUINE BANDAGING - The Foot
52
EQUINE BANDAGING
The Foot
The hoof is difficult to bandage because of the tendency for dressing to ride upwards
onto the pastern, and because of the high ‘wear-rate’ of ambulatory patients. The
problem of ‘riding upwards’ can be minimized by ensuring that the bandage is
extended downwards over the heels, and taking at least several layers under the heels
of the hoof.
General guidelines:
Bandages on the foot have a high tendency to become soaked with water, soiled
bedding, or urine and faeces. This means that wicking effects for infection are likely
under most circumstances. In some cases the dressing can be protected from wet
by placing the dressed foot into a high-density polythene bag and taping the bag
onto the foot. It may be possible therefore to make the dressings waterproof but this may
encourage sweating and heat and so this can be viewed as a disadvantage.
53
ANATOMICAL DIRECTIONS AND
SELECTED POINTS OF A HORSE
54
55
GLOSSARY
I/V: Intra-venous.
56
GLOSSARY
continued
METATARSAL: The bones and structures between the hock and digits
of the hind limbs.
METACARPAL: The region between the carpus (wrist) and the digits of
the forelimb.
MIDLINE: Line down centre of an animal longitudinally, nose to
tail when viewed from above.
PREFIXES
DYS: Painful or difficult.
HAEMA/HAEMO: Relevant to blood.
HYPER: Indicates excess (above normal).
HYPO: Indicates deficiency (below normal).
PRE: Before the item or event.
POST: After or behind.
57
Years
Supplying the UK
Veterinary Profession
www.millpledge.com
A True Conforming Bandage
KNIT-FIX™ KNIT-FIRM™
A non-slip veterinary bandage A multi-purpose veterinary bandage
Illustration of
ORTHOBAND® applied
to the foot and lower limb.
Electrocardiographs
Infusion Control
Ultrasound Equipment
Suction Unit
Diagnostic Sets