Surgery STAT: Tie-over bandage: a solution for wounds in difficult locations
EDITOR'S NOTE: SurgerySTAT is a collaborative column between the American College of Veterinary Surgeons (ACVS) and DVM Newsmagazine. This month, John C. Chandler DVM, MS, Dipl. ACVS Small Animal Surgery, writes about a solution for wounds in difficult locations, the tie-over bandage. Dr. Chandler is with WestVet Animal Emergency and Specialty Center in Garden City, Idaho. In July, Peter J. Lotsikas, DVM, Dipl. ACVS Small Animal Surgery, writes about metacarpal and metatarsal fractures. Dr. Lotsikas is with Veterinary Orthopedic & Sports Medicine Group (VOSM) in Annapolis Junction, Md.
The tie-over bandage is a simple, inexpensive, versatile bandage that has many applications in veterinary medicine. It can be used with a variety of dressings and to cover wound configurations in many different locations. It is especially useful for covering areas that are otherwise challenging, such as the shoulder, neck, trunk, hip, inguinal region, perineum and caudal thigh.
Experience with the tie-over bandage has provided a few helpful hints. A minimum of five loops are needed to provide adequate points of fixation for the umbilical tape. When five loops are used, the umbilical tape can be laced in a "star" pattern.
If more than five loops are used, the umbilical tape can be laced similar to a shoelace. The loops should be large enough to allow easy passage of the umbilical tape using a mosquito hemostat or forceps, yet not so large that they crowd adjacent loops when pulled tight.
If loops are too long, it is difficult to obtain the amount of tension necessary to hold the dressing in place. A common mistake is to leave the umbilical tape too loose, resulting in slippage of the dressing. In addition to holding the dressing in place, the tension on the loops also may provide a degree of skin stretching to aid later in closure.
Tie-over bandages can be used to hold a variety of primary dressings in place. The most common primary dressings include wet-to-dry dressings and nonadherent dressings. Wet-to-dry dressings typically include saline-soaked (isotonic or hypertonic) gauze sponges or laparotomy pads.
Nonadherent dressings usually consist of Telfa or Vaseline-impregnated gauze. The protective layer of the tie-over bandage should consist of a layer of sterile gauze sponges, towels or laparotomy pads. A water-resistant paper surgical drape can be cut to size and placed over the protective layer to prevent contamination if desired.
Dr. Chandler is a board-certified ACVS small-animal surgeon. After completing his residency at Colorado State University, Dr. Chandler joined the WestVet Animal Emergency and Specialty Center in Garden City, Idaho.