A common question among horse owners and veterinary students is: When is it appropriate to bandage a leg or wound and, if it is, what is the best material with which to bandage it? There is an ever-growing variety of commercial bandaging materia
A common question among horse owners and veterinary students is: When is it appropriate to bandage a leg or wound and, if it is, what is the best material with which to bandage it? There is an ever-growing variety of commercial bandaging material available to the horse owner and veterinarian. In one of the 1997 editions of a major tack store’s catalogue, there are eleven full pages devoted entirely to bandaging material and “leg apparel.” Much of what is used boils down to personal preference, but there are some basic rules that need to be followed. A poorly applied wrap and bandage or some types of bandage material applied in the wrong situation can without question do more harm than good.
A general theme that applies to all bandaging from the simplest of shipping wraps to the most elaborate of full leg medical bandages is: If there are wrinkles or bunches, the bandage is dangerous; if there is not an adequate thickness of “wrap” material under the bandage, the bandage is dangerous; if the bandage is too loose, the bandage is dangerous.
Most improperly applied bandages are too loose rather than too tight. When asked how tight should a bandage be applied, the obvious response is, “not too tight.” That is similar to being asked what does pumpkin pie smell like. “A pumpkin, of course.” A big help, right?
A commonly used “gauge” of bandage tightness is to “thump” the bandage. A properly applied leg bandage, if you flick it hard with your finger, should resonate a sound similar to that obtained when “thumping” a ripe melon or pumpkin. This is still subjective, as one person’s idea of a ripe melon may be different than another’s, but the general idea is that the bandage should be uniformly snug.
It is important to ensure that there is an adequate amount of wrap material under the bandage. This provides protection, but it also distributes the forces applied by the outer bandage and helps prevent any excessive localized constriction. Most of the commercial wraps, which consist of one-quarter inch to one-half inch thickness of soft material that is of a sufficient length to make it around the leg three to five times, are adequate.
For a number of bandage applications, the leg wrap will be made from individual sheets of commercial “sheet cotton.” (The stand-ard size of “sheet cotton” is 30 inches by 36 inches.) The sheet cotton can be folded in a variety of ways to create a custom length to fit the leg, and it should consist of a minimum of four or five individual sheets. The important thing is to take care in the folding of the individual sheets and to make sure that there are no “wads” or thick seams that could create focal points of pressure on the leg.
Of paramount importance is to apply a well-padded bandage snugly enough (with absence of wrinkles) to prevent it from slipping. When a leg bandage slips, it might just slide down and annoy the horse. However, the worst-case scenario is a bandage that slips in such a manner that it bunches and applies a pressure point on the back of the tendons. This occurrence can precipitate a so-called “bandage bow” or tendon damage.
The general standing bandage is the one that many performance horses have perfectly displayed on their legs for half of any given day–snug, clean, wrinkle-free, and thumping like a Miracle Grow-fertilized pumpkin. These general-use bandages and wraps can be purchased or custom-made as mentioned above. The main functions of these general bandages are to provide protection; cover various leg sweats, paints, liniments, or poultices; and provide support. The support can aid in reducing any “stocking up” or wind puffs, but the actual “support” or assistance in weight-bearing that is provided to the tendons and other leg limb structures is not as much as many owners think.
For example, if you think in specific terms of how much force or weight are carried by the tendons of the forelimbs, it is easy to question how much “support” a typical standing wrap and bandage can provide.
When a horse’s leg is fully bearing weight, the flexor tendons and suspensory ligament on the back of the leg feel like tight cables and can be perceived to be as hard as the cannon bone itself. But, when the leg is picked up and the same tendons and ligament are palpated, they are soft and floppy–when weight-bearing, these tendons do act as suspension cables, so to speak, and hold the fetlock up. If these tendons and ligaments are transected by injury, the fetlock will drop to the ground. The forelimbs of a horse carry 60-65% of the horse’s body weight. For a 1,200-pound horse, this puts approximately 360 pounds of weight down a single forelimb (when only standing at rest in the stall!).
In a 1992 issue of the American Journal of Veterinary Research, a paper was presented that evaluated the ability of three types of standing bandages to reduce the strain placed on one of the sesamodian ligaments. The research project involved inserting a small strain gauge in the ligaments of eight horses and measuring the normal resting forces applied to the ligament. The researchers then evaluated how the various wrap and bandaging material affected the forces. In addition, both a ridged splint and a fiberglass cast were evaluated.
It was determined that there was no significant reduction of the ligament strain with any of the three bandaging combinations. The splint did reduce the strain, and the fiberglass cast, as would be expected, reduced the strain the greatest.
The primary functions of placing a wrap and bandage over a wound are to provide protection, place a clean environment next to the wound, and provide general support to the tissues surrounding the wound. In addition, the bandaging of lower leg wounds is generally thought to reduce the formation of exuberant granulation tissue, or proud flesh.
When a wound is in a high-motion area, such as over a joint, an appropriate wrap and bandage will create some degree of immobility that can increase the chance of a primary repair (suturing) being successful. Bandaging these types of wounds also can improve the cosmetic and functional aspects of the healing. These wraps and bandages are commonly referred to as “stack” or “stove-pipe” wraps, and they generally consist of two of the standing bandages “stacked” on top of each other. These wraps can be difficult to apply, especially to the hind leg, since the curvatures of the hock must be navigated. These wraps are prone to slipping with leg motion. Therefore, owners frequently employ the elastic and conforming properties of bandage material such as Vetwrap or Elasticon. With the full leg wraps and bandages, it is important to cut a small tension release in the outer layer of bandage just over the bony prominence behind the carpus and hock as pressure sores can develop in these areas.
With a wound that cannot be primarily repaired (typically an older wound that has become infected or a wound that has lost a large amount of tissue), the type of sterile dressing applied directly to the wound depends on the stage of healing. The two major types of dressing are adherent and non-adherent. For wounds that are infected and producing a considerable amount of drainage or pus, the adherent type of dressings generally are chosen. The adherent dressing actually aids in the healing process early on by helping to debride the wound when it is removed. When the wound bed becomes more healthy with granulation and the exudate or pus decreases, a non-adherent dressing is favored. With both of these direct dressings, an absorbent layer of clean bandage material is smoothly applied over them, then all are covered by a standing wrap and bandage.
There is a plethora of commercially available leg protective gear. Everything from the simple one-piece cannon bone area coverings with Velcro attachments, to a one-piece, full-length coronary to above the hock or carpus Velcro attachment style. The choice of what to use obviously needs to take in the individual horse’s needs, i.e., is the horse a rock-solid shipper who has the travel experience of Captain Kirk, or does he come completely unglued and slip into that self-destruct mode every time he even hears the trailer move in the yard?
In my opinion, the rock-solid shipper variety, if they are going to injure something, usually are going to damage the coronary band or heel area from a bad cross-step on a bumpy road or too quick a start, stop, or turn. Yes, they can injure anything else that gets in the way, but this area is most vulnerable–especially if the horse is wearing shoes and even more so if the shoes have toe grabs, heel grabs, or other traction devices.
Also, these coronary injuries can be a nuisance to deal with after the fact; they can be particularly painful and can cause lameness that might prevent the horse from doing what you want at the end of the trailer ride. In addition, damage to the coronary band area can result in a permanent abnormality of hoof growth that can cause long-term problems.
Bandaging and/or the use of bell-boots can help prevent or at least lessen the severity of those types of injuries, if they properly cover the coronary area. That is the big if.
I see many horses shipping in and out of shows and the clinic with exceptionally well-applied bandages that stop just below the fetlock and leave the coronary area wide open to attack from the other foot.
It also is important to make sure that if bell boots are used, that they are the appropriate size–I have seen many coronary lacerations occur despite bell boots because the boot was too large for the foot and did not cover the coronary in the area of the heel.
My personal preference is to use the commercial “pillow” or “quilted” type of wraps that are both the appropriate length for the leg and are of a quality to provide thick padding. The material should extend from just below the carpus or hock to over the coronary band by one inch. My preference of bandage material to apply over the wrap is commercially available flannel that is six inches in width and 10 to 14 feet in length, depending on the length of the horse’s leg. Many people make the flannel bandages themselves out of bulk flannel material available at almost any fabric store. The nice thing about flannel is that it tears easily in a straight line, so once you’ve measured the six inches, the rest is easy. This arrangement also provides adequate protection of the upper leg and tendon areas.
If the horse requires more extensive protection, many of the commercially available full-leg shipping boots work well. In most cases, these are used in an effort to protect the hock of a chronic kicker. It is very difficult to bandage the hock so that the bandage stays in the proper position and does more good than harm. In addition, hock bandages might make some horses kick even more, and despite the best of bandages, they’re often no match for the forces incurred by a kicking horse. It is important, if a hock bandage is going to be used, that it fit the hock/leg well and be secured adequately to prevent slipping. In addition to the protective hock gear, padding the back and/or sides of the shipping stall can be extremely beneficial. There are many sources of commercial “kick” padding available for this purpose.
It also is important to double-check padding to ensure that it will not fall under the horse in transit and cause the horse to “freak-out” or become ineffective protection.
The wraps mentioned above are my preferences and do not reflect any superiority. The important points to remember, regardless of material used, are that the wrap, bandage, or other leg protection fit the leg well and be adequately secured without slipping or bunching.
One final note: The tail is frequently bandaged for a variety of reasons, most of them associated with reproduction-related events. Although it might seem relatively harmless to apply a bandage to a horse’s tail, it occasionally results in a particularly nasty complication. If an elastic material is used, it is easy to apply a force sufficient to constrict or cut off blood flow to the tail. In addition, some of the commercial elastic bandage materials can shrink after getting wet and drying and become a constrictive force even if the original bandage was not applied too tightly.
The overall effect of this constriction, if allowed to go on long enough, can be the death of the lower part of the tail and the subsequent need to amputate that part of the tail. Care must be taken when applying a tail bandage since the absence of padding under it makes it easy to apply too tightly. If the bandage is to be left on for a significant amount of time, it should be monitored to ensure that it does not become too tight or bunch up and cause constriction.
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