Management of Bandage and Cast Soft Tissue Injuries

Bandage and cast injuries of the distal limb are rarely reported in either the medical or veterinary literature, but anecdotally are common. In a retrospective study of iatrogenic soft tissue injuries referred to the plastic surgery department in a human hospital, 196 patients were identified in a 4 year period, 37% were due to extravasation of medicants, cast induced ulcers accounted for 28% and only 5% were due to elastic bandages. Interestingly nearly 50% of the elastic bandage injuries were in neonates that would not be able to communicate pain associated with the bandage (much like our patients). The incidence of iatrogenic injuries or cast/bandage associated injuries in veterinary care is unknown. One retrospective small animal veterinary study reported the incidence of complications associated with casts, finding that 63% could be expected to have a soft tissue injury during external coaptation, of which 20% were classed as severe. Sighthounds were significantly more at risk and soft-tissue injuries were not linked to the duration of casting. In an equine study of half or full-limb casts, complications were recorded in 49% of horses, of which cast sores were the most commonly reported.

In order to prevent or manage bandage and cast injuries it is important to understand how they arise. In most situations it is not possible to permanently remove the dressing as it is providing a function to assist healing of the original injury. Complications associated with bandages and casts vary in severity – minor complications include joint stiffness, disuse osteopaenia, muscle atrophy, superficial dermatitis or pressure sores and more severe complications include full thickness skin loss at local pressure points, ischaemic necrosis of digits or pads, or full limb ischaemia resulting in amputation or even death. Pressure on the limb is caused by a combination of factors including the pressure of the externally applied material, reperfusion injury and oedema, or swelling of the limb within the bandage or cast.  [...]