“Bandaging is the bane of my world.”
These words were recently spoken by Dr. Noel Fitzpatrick, the world-renowned veterinary orthopedic and neurosurgeon. This echoes the sentiment of many in our profession. Bandages are ancient, dating back to the early Egyptians, and many chapters in veterinary texts and even entire books are dedicated to their design and application.
Although many other areas of veterinary medicine have radically changed, bandaging techniques have changed little. How many of the bandages you have recently applied look like something out of King Tut’s tomb? The materials that we now commonly use—such as Vet-Wrap, Elasticon, nonadherent semi-occlusive sponges, hydrogel dressing and calcium alginate dressing—have superior properties for bandaging and have replaced white linen strips and cotton batting.
The aural compression bandage.
Yet we still use some techniques from the King Tut days with honey- or sugar-based bandages.
We would all like bandaging to be a science, masterable by the majority of practitioners simply by exact and consistent following of a set of well-understood steps. The reality is that it is currently more like an art, where skill and imagination applied to basic materials are uniquely combined.
Two people following the same set of steps and using the same materials can produce very different results; one achieves the therapeutic goals, remaining in place and not causing further complications; the other bandage does not achieve the therapeutic goals, falls off or causes skin irritation, edema, ischemia and or even necrosis.
DogLeggs can protect elbows from more trauma.
Modern bandaging products can enable many more in the veterinary community to provide effective and safe bandaging.
Let’s take two common bandaging situations, the aural hematoma and decubital ulcers of the elbow, and look at how they are traditionally bandaged, common issues associated with those techniques and how modern products can address those issues.
Whether an aural hematoma is treated by needle aspiration, tube drainage systems or incisional drainage, it is common to place some form of a bandage around the head to protect the site from infection or further damage by the patient and to absorb fluid, avoiding a mess in the owner’s house.
The bandaging materials are often a nonstick gauze pad or mesh gauze held in place by either an elastic bandaging material or stockinette.
The major issue is keeping the bandage from sliding off the front of the patient’s head or becoming a second collar. Problems can get even worse when the client attempts to change the absorbent layer at home. A sticky elastic bandaging wrap can help, but it can also roll into a band or irritate patients, causing them to scratch or rub it off.
An e-collar can be used, but now you have an irritated, frustrated and confused patient, banging around the house and, in addition, an equally irritated, frustrated and unhappy owner. Even with an e-collar, if the bandaging falls off you can end up with a scene out of a Halloween slasher movie.
A next-generation product for such uses is a compression garment such as the DogLeggs’ Aural Compression Bandage. The premade unit is constructed of a unique textile that breathes, provides excellent compression and protection, and does not stick to an incision site.
Since it does not depend on adhesives to stay on and does not pull guard hairs, the patient remains comfortable.
This product slides over the head and secures in front of and behind the pinna with hook and loop closures. A single person can apply it in under a minute. The product is washable and may be used multiple times.
“DogLeggs’ Aural Compression Bandage is the standard way we bandage the head and ear,” says Chris Carskaddan, DVM, of Clocktower Animal Hospital in Herndon, Va. “For aural hematoma patients, we now typically place a drain and bandage with the bandage. No more blood everywhere when using the e-collar, and the patient’s owners and clinic staff are all much happier.”
The cost of the product ($34.95) might seem high compared to some elastic wrap, a piece of gauze and an e-collar. But once you add to that the cost of two and sometimes three vet techs spending 15 to 20 minutes applying the bandaging material multiple times during the healing phase, the economics are quite favorable.
In addition, these new bandaging solutions are beginning to be covered by many pet health insurance policies when rescribed by a veterinary professional. Add to that the cost in both dollars and time to the owner for multiple return visits for bandage changes or complications, and the initial cost of the compression bandage suddenly becomes minimal.
Bandaging on any limb is difficult and the elbow is especially tricky. A bandage here must be tight enough to stay on but not so tight as to cause edema, and it must allow for sufficient movement. Bandaging elbows is an art that many do not possess.
To allow decubital ulcers at the elbow to heal, there must be proper coverage for an open wound, sufficient padding to prevent further trauma from pressure and enough joint movement to prevent a constricted wound.
The traditional bandaging is a doughnut bandage or a windowed forelimb spica bandage and splint. A good description of this technique may be found in NAVC Clinician’s Brief, July 2005, Page 21.
The spica bandage is complex and requires a great deal of practice for proficiency, and it is easy to lose aptitude if you have not done one for a while. Similar to the issues in aural compression bandaging, the use of sticky elastic bandaging material can lead to skin irritation and pulls on the fur and annoys the patient, encouraging the animal to remove it.
The proper tension for traditional bandaging, even if it can be achieved at the clinic, often does not remain. In many cases a bandage loosens and falls off, or—even a greater problem—tightens in one or more areas to cause edema, ischemia and/or necrosis.
The Standard Adjustable DogLeggs bandaging garment provides the needed coverage, sufficient padding and proper joint movement. The over-the-shoulder design keeps the bandage in place at the elbow without constriction, falling off or irritating the skin. If foam insulation is required, it is possible to cut to form a doughnut pad and to suspend the bandage over the wound and allow for open-air granulation.
Effective bandaging is critical to any practice’s success and the availability of true bandaging artists is limited. As with any procedure that requires such a level of artistic ability, it can be difficult to charge enough to compensate for the investment in time and resources used.
Fortunately, new product solutions are available to veterinary professionals and their customers for effective and safe bandaging that does not require excessive skill, dexterity, imagination or time to apply.
Dr. Winkler is a board-certified surgeon who practices at Georgia Veterinary Specialists in Atlanta.
This Education Series article was underwritten by DogLeggs of Reston, Va.