A Pressure Bandage How-To

Over the past year I have become somewhat skilled at applying pressure bandages to legs - equine legs not human. It started with Izzy's hind leg which required pressure to discourage the over granulation of tissue (proud flesh) as the wound closed. 

Rear leg bandage

Wound

If you're a new visitor, you can read all about Izzy's wound including how he got it and what it looks like today. Just follow the Izzy's Leg link on my blog side bar. There are enough posts there to keep you busy for at aleast a few hours. 

Now that Speedy has been diagnosed with "tendonitis" (my vet didn't want to give it the classic bowed tendon label because a bow is such an ugly word), I am once again applying a pressure bandage. This time it is to a front leg. And just to insert an update here, Speedy's leg looks so pink because Dr. Tolley shaved it down to bare skin for the ultrasound. The small bit of swelling that appeared over the weekend is already gone.

Here's where the damage is. The swelling is already gone.

I know some of the people who follow my blog don't have a lot of experience treating wounds that aren't simply superficial, so I thought I'd share one way to do a pressure bandage. Surprisingly, it's easy to do and mostly requires a good grip with a little muscle power. To start, here are the materials that you'll need.

• For a sweating/poulticing/wound treatment bandage: Furacin, a poultice, or other "wet" topical. If the bandage is simply for pressure with no need to sweat the leg or treat an open wound, skip the topical and the next step (plastic).
• Plastic wrap - I am using an arm length long glove that the vet uses for rectal or vaginal exams. I cut the "hand" off and sliced lit open long ways. You can also use plain old kitchen plastic wrap. If you're doing a dry pressure bandage, don't use plastic.
• Cotton sheeting - I use BB Satin Star 12's which are actually folded in half to make a 15" x 36" sheet.
• Brown cling gauze - 6" by 5 yards. I buy mine from the vet, but you can get it at places like Amazon or others.
• Vet wrap - Big Dee's carries the brand that I prefer, Ren Flex Bandage Tape, and their pricing is excellent. I buy it in bulk as it seems as though I constantly need a roll.

Ready to wrap

Before you start, I've found a couple of things to be helpful. First, make sure your horse is pretty immobile. Both of my boys have learned to stand while I work on them. If your horse isn't patient now, it would be a good idea to work on this now so that you won't have to fight with him when it counts. Secondly, and I learned this through experience, make a neat pile of your materials and put them within arm's reach. There is nothing more irritating than having to let go of the cotton because you can't reach the gauze. Ask me how I know!

And with that, here's how to apply a pressure bandage:

1. Slather the leg from top to bottom with your wet ingredient.
2. Place the wrap along the outside of the leg and hold it in place by pressing firmly in the middle, not the top. I always wrap inward (clockwise in this case) so that I can pull towards myself which allows me to use my whole body to get the bandage tight. 
3. Hold the plastic firmly against the leg so that it doesn't slide around. Roll the cotton sheeting loosely like a standing bandage. Place an end of the cotton in the middle of the outside of the leg (in the grooves created by the tendons) and begin wrapping around the back of the leg first, coming out toward you.
4. As you pull, hold the end of the cotton and the plastic firmly in place as you tug the cotton tightly. This is a pressure bandage, so get it as tightly wrapped as possible.
5. Hold the cotton firmly against the leg and place an end of the gauze in the same place where you started the plastic wrap and cotton sheet, in the center of the outside of the leg. 
6. Again, begin to wrap by going around the tendon side of the leg so that the bandage comes out over the front of the leg. It's important to pull tight over bone and not over the tendon. To make a true pressure bandage, you need to pull so tightly that you almost hear the bandage begin to rip. I can never get mine as tight as the vet, but I know I am getting close when the gauze begins to look stretched out.
7. As you wrap, layer the gauze by half, and each time you come over the front of the leg, pull as tightly as you can. Wrap under the fetlock just like you would for polos, but leave one to two inches of cotton sheeting sticking out. This will help keep dirt out of the bandage, and it prevents the bandage from rubbing.
8. Once you've wrapped under the fetlock, begin spiraling up the leg by wrapping about half way over your last layer. Remember to pull tightly as you come over the front of the leg.
9. When you come to the top of the bandage, leave one to two inches of cotton sticking out and then begin spiraling back down to the point where you started.
10. When you get back to the middle of the leg - the outside, cut your gauze. The gauze will adhere to itself slightly if you pat it down.
11. Begin wrapping with your vet wrap. Again, start in the middle of the outside of the leg where you left off with the gauze. You do not need to pull the vet wrap tight. The brown gauze is where the pressure comes from. The vet wrap's job is to simply secure everything.
12. Again, spiral down leaving one to inches of the cotton sheeting showing. Spiral back up to the top and leave the cotton sheet exposed. Spiral back to the middle and cut the vet wrap so that it adheres to the middle of the outside of the leg. 
13. Follow your veterinarian's advice, but it is standard to re-wrap every other day.

Done!

That's it. I can get a leg bandaged in under five minutes once I've got everything laid out. One of the reasons I like to start and stop my bandages in the same place is so that when I take it off, I can find the ends. While you can cut it off, I hate sticking sharp scissors down the leg; I prefer to unwind my bandages for removal.

There are many ways to bandage. Some people like to always go counter clockwise, no matter which leg, and others like to spiral up and then down. I am not sure that it actually matters. I am simply following my vet's suggestions, and since it has worked so well, it's the system I use. Please share if you have any special tricks or tips to make the process easier.