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The Art of Bandaging

Bandaging is an art. It is a skill that every technician, new or experienced, should continue to hone throughout their career. Bandages themselves are multifaceted. Proper selection and application are critical components of wound healing. Understanding the properties and functions of bandages is key to correct selection and will aid in a successful application.

Published May 1, 2023

By Danielle Browning, LVMT, VTS (Surgery)

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May 2023

Advanced Training for Techs

Bandages are used to provide stabilization, compression, absorption, and protection and to deliver medications, and proper bandaging is an art. It is a skill that every technician, new or experienced, should continue to hone throughout their career. Bandages themselves are multifaceted. Proper selection and application are critical components of wound healing. Understanding the properties and functions of bandages is key to correct selection and will aid in a successful application.

Depending on the desired function, selecting the bandaging materials used for each layer will vary from case to case. Considerations for choosing a particular dressing or material will depend on a range of factors. Some factors to consider would be the presence of an open wound, recent surgery, wound drains, infection, environment, patient temperament, cost, inventory, and owner compliance.

Generally, bandages can be broken down into three layers: the primary, secondary, and tertiary layers. There are times when only a primary layer is necessary or a secondary layer may be left out entirely. Remember to use an aseptic technique, wash hands, and wear clean gloves when applying a bandage, especially when handling materials that come in contact with the wound.

The primary layer is the first layer of a bandage that comes in direct contact with the patient. Rolled cotton and cast padding are often used as the initial layer; however, these materials should never be placed directly on an open wound surface, since the cotton fibers can become lodged in the wound bed, inciting inflammation. If the primary layer is covering an open wound surface, a nonstick material such as a Telfa pad should be used. Stirrup tape strips can be useful to hold the bandage in place (Figure 1). The stirrup is first applied directly to the skin, then folded over attaching to the last gauze layer (Figure 2). Stirrup tape strips should never be placed directly on an open wound, skin graft, incision, or over the accessory carpal pad since excessive traction may result in tissue necrosis. The stirrup technique is commonly used when bandaging the limbs and can be applied to the head and tail as well.

Fig. 1
Figure 1: Applying stirrup tape strips to the skin.

Fig. 2
Figure 2: Folding stirrup tape strip into the secondary layer.

Fig. 3
Figure 3: One to two layers of rolled gauze comprise the secondary layer in most soft-padded bandages.

Fig. 4
Figure 4: The “donut” technique, which distributes pressure around bony prominences to reduce the incidence of pressure sores.

Fig. 5
Figure 5: The tertiary layer is the outer covering of the bandage.

The secondary layer provides absorption, compression, and stabilization to the bandage.

Multiple layers of cast padding, followed by one to two layers of rolled gauze, comprise this layer in most soft padded bandages (Figure 3). If a splint is also being used to add support, it will be incorporated into the gauze layer, and additional layers will be required to hold the splint in place. Rolled gauze is at risk of being wrapped too tight, so care should be taken to pull the gauze tight enough to not sag, but not overtightened so it results in constriction. Adequate padding under the splint and around bony prominences helps to reduce the risk of pressure sores associated with bandages. Sponges, foam, cast padding, and orthopedic felt are materials that can be used to provide adequate padding. A common mistake is to add additional layers of padding on top of bony prominences, but this is counterproductive, creating more pressure on the area. Instead, utilize a “donut” technique, which distributes the pressure around the area to reduce the incidence of pressure sores (Figure 4).

The tertiary layer is the outer covering of the bandage (Figure 5). This layer’s primary role is to hold the first two layers in place; it also protects the wound from potential infectious agents and shields the environment from contamination by the wound. Adhesive surgical drapes, or transparent films, can be used to create an occlusive barrier. Bandages are further broken down into occlusive and semiocclusive, which relate to the breathability of the material. Occlusive bandages are impervious to air and fluid, creating a “waterproof” layer, while a semiocclusive layer will be moisture-retentive and absorbent, allowing for some evaporation and vapor transfer. Understanding the properties of the bandage material is prudent for getting their most effective use. The most common tertiary layer is an elastic wrap, and care is taken to not put this material on too tight. The higher the elasticity of the material, the greater the constriction risk.

Alternative Bandaging Techniques

Keeping a wound covered is crucial and can be a straightforward process. However, when dealing with wounds located on the head, chest, flank, tail, and inguinal region, a traditional padded bandage may not be the best option.

A tie-over bandage is an alternative method to keeping wounds in these areas covered. To place a tie-over bandage, the patient is sedated, and suture loops are placed in the intact skin. The loops are placed around the perimeter of the wound bed approximately 2 to 4 cm from the wound’s edge. The primary and secondary layers of the bandage are applied to the wound and held in place by passing umbilical tape (or a clean shoelace) through the loops, similar to lacing a shoe. This technique is also useful to help stretch the intact skin when skin-to-skin apposition is difficult. An adhesive drape can be added over the top of a bandage for an occlusive tertiary layer. When changing a tie-over bandage, cut the umbilical tape and leave the suture loops in place. Once removed, the wound can be cleaned and redressed; often this change can be performed without sedation. Wound drains should be covered with a tie-over bandage or soft padded wrap to decrease the risk of ascending contamination and infection. This is especially important with the use of passive (Penrose) drains.

Less is often more, especially when dealing with cats and small dogs. Consider the use of an adhesive bandage (e.g., a Band-Aid) to cover smaller wounds and incisions when compression is not needed. An adhesive bandage can be easily constructed using a nonadherent dressing and a slightly larger size transparent film. The intact skin should be clean and completely dry to allow the tape to adhere. Spraying the intact skin with an acrylate polymer will help with tape adhesion and prevent stripping of the skin when the adhesive is removed. This type of barrier film is also used to protect the intact skin from body fluids that may lead to maceration, causing an increase in the risk of infection. Proper skin preparation, before placement of tape or transparent film, is key to ensure good adherence.

When to Change a Bandage

When wound care is not required, a bandage that remains intact, clean, and dry may stay on for weeks. Bandages should always be changed when a strike-through (appearance of fluid or blood to the outer layer) occurs and preferably before that happens (Figure 6). When dealing with open wounds, the decision for when to change the bandage will depend on the status of the wound, the primary layer chosen, and, ultimately, is the decision of the veterinarian. As a rule, if the integrity of a bandage is questionable, err on the side of the caution and change the bandage.

Fig.6 Figure 6: An example of an adhesive bandage with strike-through on the hip of a dog.

During all bandage changes, the surrounding areas (periwound skin) should be monitored for swelling, edema, skin irritation, or pressure sores. If any are noted, adjust the next bandage to elevate or prevent the issue from worsening or consider leaving the bandage off. Use a silicone medical adhesive remover to remove any tape and adhesive from the skin.

At-Home Care

Owners should be given clear instructions on bandage care and encouraged to call if they have any concerns. When sending a patient home with a bandage, make sure to keep good communication with the owner and give them written discharge instructions on proper bandage care. For example, when sending a patient home with a soft padded limb bandage, the instructions should include: keeping the bandage clean and dry; checking the toes for coldness, separation, and swelling; and keeping the e-collar on at all times.

Owners will need to monitor the bandage for any discharge, foul odor, slippage, or swelling around the bandage. They should notify their veterinarian’s office immediately if any of these signs occur.

Tips for Soft Limb Bandage Application

Apply 1-inch white tape stirrup strips (optional).
Begin at the toes, leaving the toenails of digit 3 and 4 exposed.
Hold the roll so the outside of the dressing is down against the patient, rolling “off” the roll.
Choose a wider size material (4-inch instead of 2-inch) when applicable to avoid the tourniquet effect.
Apply layers in a spiral fashion, beginning at the most distal area working proximal.
Leave a few millimeters of each underlayer exposed as you build up the bandage.
Aim for 50% overlap of material.
Avoid excessive wrinkles in the material.
Pull cast padding to flatten the quilted appearance. The cotton cast padding material will tear before it is too tight.
Use even tension (not too tight) when applying the rolled gauze layer.
Adequately pad around bony prominences with a donut.

An effort needs to be made to make sure the patient does not prematurely remove their bandage. Patient molestation (chewing at the bandage) could result in infection, additional wounds, incisional dehiscence, or a gastric foreign body. Patient molestation is a serious concern and needs to be prevented. Neck collars, e-collars, side-bars, body suits, and t-shirts can be used to deter the patient from traumatizing the affected area. It is important to note that e-collars must extend past the patient’s nose to be effective. If a patient suddenly begins to chew on the bandage, consider there may be an underlying problem rather than just an unruly animal—immediately remove and replace the bandage.