Wrap up your knowledge about surgical bandages

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Postsurgical bandages can help the wound heal and aid in patient recovery, however Michael H. Jaffe, DVM, MS, CCRP, DACVS, associate professor and service chief of small-animal surgery at Mississippi State University College of Veterinary Medicine, stressed that these bandages need to be placed correctly in order to have any advantages. Because of this importance, Dr Jaffe shared his best practices for placing bandages during his session at the Fetch dvm360 conference in Long Beach, California.¹ He broke down this topic into the 3 basic layers of bandages as follows:

• Contact (primary) layer
  • Touches the wound directly
• Intermediate (secondary) layer
  • Holds the contact layer in place
• Outer (tertiary) layer
  • Holds the intermediate layer
  • Provides an external barrier (while also protecting inner layers)

Contact (primary) layer

“This is actually the most important: The primary layer, because this is what is coming in contact with the wound (something that has damaged the integrity of the skin) … this is what's coming in contact with anything underneath the skin, and the external world. This has to be placed in a sterile manner and aseptically,” Jaffe said.

He recommended choosing the material for this layer based on the wound’s exudative status. For example, if the wound is healing from an infection, the bandage needs to draw the infected fluid or tissue away from the wound. This bandage would also need to be changed frequently, usually daily, but it depends on the specific case. Adherent dressings could include dry or moistened gauze. A wet-to-dry bandage can also be used to debride an infected wound. Jaffe mentioned that the goal with these bandages is to have the absorptive ability be greater than the amount of fluid that is being produced by the wound. And for heavily exudative wounds, Jaffe advised attendees to make sure the bandage is drying out the wound.

With granulating wounds, the primary layer needs to protect its environment to allow for uninterrupted vascular in-growth. This bandage does not get changed as often, usually every couple of days, but, again, it depends on the case.

Nonadherent dressings could include petrolatum saturated gauze or hydrogel products. “These have some [lubrication] on them, so they don't stick to the tissue. And all of these have some degree of oil base or high water content, so they don't stick to the tissue. Because once it sticks to the tissue, and we peel it off, we’re disrupting that superficial layer of the wound. And that's the last thing that we want to do when we're trying to cultivate a nice, healthy granulation tissue bed,” Jaffe said.

Intermediate (secondary) layer

The function of the secondary layer is to hold the primary layer in place and to prevent dead any space. It is generally composed of an inner cotton layer and an outer gauze layer. According to Jaffe, the inner cotton layer is meant to absorb fluid from the primary layer, provide pressure to the primary layer, support and immobilize the tissue, and protect the wound.

“We're going to put our primary layer down, and then we're going to use our cast padding around that and then our gauze,” Jaffe said. “When you put your cast padding on, you can't really put that on tight because it tears, but it will at least conform to the anatomy of the area that you’re bandaging. When you put the rolled gauze on over that cast padding, that's where you want to kind of make it a little bit tighter.”

He advised veterinary professionals to be careful not to make the rolled gauze too tight, as to not damage the tissue, however, make it tight enough that there are no air spaces. “The pressure actually relieves some of the discomfort and pains. When we put these on really good and snug, it actually acts as a pain reliever to some degree. It's why dogs, whenever they come in with a fracture, they always tend to want to lay on the side of the fracture, because that pressure actually makes them feel good,” Jaffe added.

Jaffe’s last reminder for secondary layers was to avoid having it come in contact with the wound. “Because it's going to stick to the incision, it's going to stick to any open draining wounds that you have, [and] you're going to get cotton fibers in there. And that's kind of counterproductive. So always make sure you're putting at least a really good primary layer down,” he said.

Outer (tertiary) layer

The tertiary layer should protect the primary and secondary layers from any external contamination and damage. According to Jaffe, this protection helps control any potential hemorrhage, limits dead space, opposes expansion of the wound edges, protects against spread of any bacteria in the wound, supports the tissue, and holds all layers in place. Examples of outer layer bandages include casts or elastic materials like Vet-Wrap or Elastikon. Either way, Jaffe recommended these materials be porous to allow fluid evaporation, but also waterproof for more protection.

Anchoring the bandages

“If the bandage is going to be on for a while, I will definitely use stirrups because these bandages like to slip distally, they like to slip from the thickest part down to the thinnest part,” Jaffe said. If stirrups cannot be used, Jaffe stated that he uses tape strips, which can be used for foot wounds to prevent it from slipping off. Torso straps and figure 8 techniques can also be used to help hold the bandages in place.

“I don't like incorporating or using the fur, I don't like taping it to the pets’ fur to help hold it up because that really does hurt these pets quite a bit. I don't recommend it. And I'm not a big fan of taping the bandage directly to the skin too, because that will cause a lot of irritation,” Jaffe said in his final thoughts.

Reference

Jaffe MH. They're NOT a Pain! Improve Your Efficiency with Bandages & Drains. Presented at: Fetch dvm360 conference; Long Beach, California; December 1-3, 2023.