Ex vivo comparison of the bursting strength of an equine ventral midline celiotomy covered by two standard abdominal bandages.

OBJECTIVE: To determine the compressive effect of abdominal bandages after ventral midline celiotomy closure in horses. STUDY DESIGN: Ex vivo, experimental study. ANIMALS: Equine cadavers (n = 18), six per group. METHODS: A 20-cm ventral midline celiotomy was created in each of 18 equine cadavers. A 200-L inflatable bladder was placed in the abdomen, and the linea alba was apposed. Horses were randomly assigned to no bandage (C), elastic (E), or Velcro inelastic (I) bandage groups for testing. Circumferential bandages were placed with a subbandage pressure monitoring system over the incision. The bladder was insufflated until construct failure, which was determined by a decrease in pressure reading. Bursting pressure, location of body wall or bandage failure, and subbandage pressures were recorded. RESULTS: Maximum bursting pressure was different between groups E and C (P = .004), with no difference between groups E and I (P = .146) or I and C (P = .085). Group I achieved higher subbandage pressure compared with group E (P = .036). Abdominal compliance was not different between groups (P = .099). Location of failure differed between groups (P = .011), with failure at the diaphragm more common in group I (6/6, 100%) compared with groups E (3/6 [50%]) and C (1/6 [16.7%]). CONCLUSION: Elastic abdominal bandages had higher abdominal bursting pressures compared with unbandaged incisions.

The effect of a compression bandage on the distribution of radiodense contrast medium after palmar digital nerve blocks.

BACKGROUND: Studies have shown proximal diffusion of injected drugs in perineural blocks; such diffusion may affect specificity of the nerve block. OBJECTIVES: To investigate the effect of a compression bandage applied to the pastern region on proximal diffusion of contrast medium injected over the palmar digital nerves. STUDY DESIGN: Experimental study, randomised cross-over design. METHODS: Radiodense contrast medium was injected over the lateral and medial palmar digital nerves of the left front limb of nine mature horses. Each horse was injected on two separate occasions, once with a 5 cm wide compression bandage applied proximal to the injection site and once without. The order of the two treatments was randomised with a wash-out period between treatments of at least 7 days. Radiographs were obtained at 5, 10, 20 and 30 min and distribution of the contrast column assessed. RESULTS: Proximal distribution of the contrast medium was significantly reduced (P<0.01) with compression bandage. Furthermore, the compression bandage inhibited lymphatic drainage of the injected contrast medium. MAIN LIMITATIONS: Clinical effect of the differences in diffusion length was not assessed. CONCLUSIONS: The compression bandage reduced proximal diffusion and lymphatic drainage of contrast material causing it to stay localised around the injection site. Use of compression bandages could thus result in increased specificity of the nerve block and potentially prolong its effect.

Effect of bandaging techniques on sub-bandage pressures in the equine distal limb, carpus, and tarsus.

OBJECTIVE: To determine the influence of 3 types of bandages on sub-bandage pressures over the distal limb, carpus, and tarsus. STUDY DESIGN: Observational study. ANIMALS: Eight healthy horses. METHODS: Each of the 6 following bandages was applied on each horse in randomized order: (1) distal limb compression bandage (DLC), (2) double layer bandage (DL), (3) inner sanctum bandage (IS), (4) carpal compression bandage (CC), (5) tarsal compression bandage (TC), and (6) adhesive elastic carpal bandage (C-ELA). Sub-bandage pressures were measured with the Picopress compression measuring system (Microlab Electonica, Nicolo, Italy) after bandage application. Carpal and tarsal bandage pressures were assessed before and after walking the horses approximately 50 m. TC pressures were also measured after creating a slit over the calcaneus. A generalized linear model was used to test the association of pressure with sensor location, bandage type, time, and potential interactions (P < .05). RESULTS: DLC (165 mmHg) and IS (167 mmHg) generated greater mean combined pressures compared with DL (146 mmHg; P = .0166). At application, CC (154 mmHg) created higher mean combined sub-bandage pressure compared with C-ELA (70 mmHg; P < .001). Pressures resulting from CC and TC decreased after walking (P < .001), whereas those associated with C-ELA were not affected. CONCLUSION: Variations to the standard DLC construct did not increase sub-bandage pressures. CC and TC pressures rapidly decreased with ambulation, whereas C-ELA pressures in healthy horses were not affected by walking. CLINICAL SIGNIFICANCE: Variations to the standard DLC offer no additional benefit in regards to increasing sub-bandage pressures. Carpal elastic bandages maintain sub-bandage pressures during ambulation and may be more appropriate for long term bandaging in ambulating horses. Creating a slit over the calcaneal tuber in TC bandages is discouraged due to rapid decreases in sub-bandage pressure.

Comparison of two cold compression therapy protocols after tibial plateau leveling osteotomy in dogs.

OBJECTIVE: To evaluate two different protocols of cold compression therapy (CCT) for pain management and functional recovery in dogs undergoing tibial plateau leveling osteotomy (TPLO). MATERIAL AND METHODS: A total of 27 adult dogs (n = 30 stifles; staged bilateral procedures: n = 3) undergoing routine TPLO were randomly allocated to three groups (n = 10/group). Dogs of group I received CCT once before and immediately after surgery. In dogs of group II CCT was performed postoperatively four times at 6-hour intervals. Dogs of the control group did not receive CCT. Circumference of the stifle joint and the following pain-related parameters were measured by a single blinded observer before surgery and 1, 10 and 42 days after surgery: stifle joint range of motion (ROM), subjective degree of lameness, and score of a modified Glasgow Pain Scale (GPS). RESULTS: Both CCT groups showed significantly greater ROM and lower GPS scores 24 hours after surgery compared to the control group. Ten days after surgery there was a significantly lower degree of lameness in both CCT groups compared to the control group. Fourty-two days after surgery a significantly greater ROM was observed in both CCT groups compared to the control group. Group II also showed a significant improvement in the degree of lameness and GPS. There were no significant differences in any of the parameters between the two CCT groups at any time point. CONCLUSION: CCT applied preoperatively and immediately postoperatively showed similar short- and long-term beneficial results compared to a previously established protocol of applying CCT four times postoperatively. This protocol may be more suitable for practical use. CLINICAL SIGNIFICANCE: The reported data can be used to establish the new protocol of CCT in a clinical surrounding and to support postoperative rehabilitation of the canine patient.

Measurement of distal limb sub-bandage pressure over 96 hours in horses.

REASONS FOR PERFORMING STUDY: Currently, there is no objective information quantifying pressures exerted by distal limb bandages. OBJECTIVES: To quantify the pressure exerted by each compression layer, a polo wrap (DLP), a compression bandage (DLC), and to measure the effect of time on sub-bandage pressure. STUDY DESIGN: Longitudinal observational experiment. METHODS: A DLC construct included a cotton roll compressed with brown gauze and elastic layers and the DLP construct included a pillow pad compressed by a cloth wrap. Dorsal and lateral sensors were placed on the mid-metacarpus. In healthy horses, sub-bandage pressures were recorded during application (n = 8) and at scheduled time points over the 24 (n = 9) and 96 h periods (n = 8). A generalised linear model was used to evaluate associations between pressure and sensor location, bandage type and time (P<0.05). RESULTS: For the DLC, dorsal and lateral sensor pressures were 187 mmHg (95% CI 185-189 mmHg) and 142 mmHg (95% CI 133-151 mmHg). Combined sensor pressure after application of the brown gauze was 80 mmHg (95% CI 75-85 mmHg) and rose to 165 mmHg (95% CI 160-170 mmHg) after the elastic layer. Combined pressure at the end of the 96 h period was 135 mmHg (95% CI 123-147 mmHg). For the DLP bandage, location but not time was significant. Combined pressures ranged between 75 mmHg (95% CI 53-97 mmHg) and 85 mmHg (95% CI 63-107 mmHg). CONCLUSIONS: Pressure distribution was not uniform. The DLP pressures were maintained for a 24 h period. The DLC maintained high pressures for 96 h, but a significant decrease in pressure occurred between 6 and 12 h. Providing there are no other reasons to change a bandage, a 4 day interval between bandages may be appropriate if maintaining distal limb compression is the principal indication.

Pilot study measuring the effects of bandaging and cold compression therapy following tibial plateau levelling osteotomy.

OBJECTIVES: To compare cold compression therapy, modified Robert-Jones bandage or the combination of cold compression therapy plus modified Robert-Jones bandage on operated limbs following tibial plateau levelling osteotomy in dogs. METHODS: Twenty-one client-owned dogs with cranial cruciate ligament disease were prospectively enrolled. Dogs were randomly assigned to one of three postoperative treatment groups: cold compression therapy, modified Robert-Jones bandage or a combination of both. Patients were evaluated preoperatively and at 12, 24 and 36 hours following tibial plateau levelling osteotomy. Measurements included weight-bearing on the operated limb, stifle flexion and extension angles and circumference of the operated limb at four levels. RESULTS: There was no significant difference in weight-bearing, range of motion or limb swelling between groups. There was a trend for dogs in the cold compression therapy and cold compression therapy with a bandage groups to have a greater increase in weight-bearing after surgery compared with the bandage-only group. CLINICAL RELEVANCE: Cold compression therapy is a safe modality following tibial plateau levelling osteotomy surgery. The trend towards improved use of the operated limb in the groups receiving cold compression therapy compared with those treated with only a bandage may be an indication that these patients are more comfortable in the postoperative period. The small sample size limits interpretation of the data but this pilot study provides data to guide future investigation.

Effects of compressive abdominal bandaging and transrectal palpation on intra-abdominal pressures in horses.

OBJECTIVE: To determine the effect of an abdominal support wrap and transrectal abdominal palpation on intra-abdominal pressures (IAPs) measured directly from the peritoneal space. DESIGN: Prospective, experimental study. SETTING: A university-based equine research facility. ANIMALS: Ten healthy adult horses, 5 males and 5 females. INTERVENTIONS: IAPs were measured through an intraperitoneal cannula zeroed at a height midway between the height of the tuber ishii and point of the shoulder. Triplicate measurements were obtained at rest, during transrectal palpation, after placement of an abdominal support wrap, and during transrectal palpation with the support wrap still in place. Simultaneous mean arterial pressures were obtained using a tail cuff and abdominal perfusion pressures were calculated using the measured IAP minus the measured mean arterial pressures. MEASUREMENTS AND MAIN RESULTS: Baseline direct pressure measurements were subatmospheric (-4.5 ± 3.0 cm H(2) O). IAPs were not significantly affected by transrectal palpation, but were significantly increased after placement of an abdominal support wrap (-1.19 ± 3.01 cm H(2) O; P = 0.01). Abdominal perfusion pressures were not significantly affected by either transrectal palpation or application of the support wrap. CONCLUSION: IAPs were significantly increased after application of an abdominal support wrap commonly used after exploratory laparotomy. Further investigations are warranted to determine the clinical implications of abdominal bandaging on IAP and its implications on postoperative complications including intra-abdominal hypertension. However, transrectal abdominal palpation likely does not contribute to abdominal hypertension in normal horses.

Effect of a stent bandage on the likelihood of incisional infection following exploratory coeliotomy for colic in horses: a comparative retrospective study.

REASONS FOR PERFORMING STUDY: Incisional infections are common in horses after colic surgery. There is a clinical impression that the use of a stent bandage reduces the prevalence of such infections. OBJECTIVE: To determine the effect of a stent bandage on the likelihood of incisional infection after ventral midline exploratory coeliotomy. It was hypothesised that the use of a stent bandage would reduce the likelihood of incisional infection. METHODS: Medical records of horses that underwent exploratory coeliotomy for colic between January 2005 and September 2011 were reviewed. Inclusion criteria were animals that had one ventral midline coeliotomy and had survived at least 10 days after surgery. Horses were categorised into 2 groups:no-stent group and stent group. The following data were collected for each case: age, sex, weight, heart rate, packed cell volume, primary lesion, performance of an enterotomy or intestinal resection, surgical classification, use of local antimicrobials, duration of surgery, intra-abdominal administration of sodium carboxymethylcellulose, intravenous administration of lidocaine, surgeon, use of a stent bandage, duration of stent use, and use of a belly band. Factors associated with the outcome measure 'wound infection' vs. 'no wound infection' were analysed using a generalised linear mixed model for logistic regression with surgeon as a random effect. RESULTS: The inclusion criteria were met in 130 horses: 55 were assigned to the no-stent group and 75 to the stent group. In the no-stent group, 12 (21.8%) horses developed incisional infections, whereas only 2 horses (2.7%) in the stent group had incisional infections. In the stent group, no incisional infections were observed during the last 20 months of the study. Statistical analysis showed that only the effect of the use of a stent bandage was significant (P = 0.005). CONCLUSIONS: The prevalence of incisional infections when a stent bandage was used was 2.7%, a finding that compared favourably to information in the literature. Use of a stent bandage significantly reduced the likelihood of incisional infections. POTENTIAL RELEVANCE: A stent bandage would reduce the likelihood of incisional infection in horses undergoing exploratory coeliotomy for colic.