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The first three steps below are standard no matter what type of agent has been extravasated.

1 Notify the attending doctor.

2 The IV catheter should be kept in place and any residual chemotherapy in the region should be aspirated back.

3 Once as much of the drug as possible has been drawn back, the catheter should be removed.

4 Place an IV catheter in a different vein to administer dexrazoxane (Zinecard®) at 10 times the doxorubicin dose (in mg), at the following intervals:Immediately (within 3–6 hours of extravasation)24 hours48 hours (1/2 dose)

5 Apply cold compress for 20 minutes immediately and every 6–8 hours for 48 hours.

Doxorubicin‐induced tissue sloughing usually appears 7–10 days after extravasation and will progressively worsen over the next several weeks to 2–3 months. Typically, in initial phases, the affected area may appear swollen, erythematous, pruritic, and/or painful. Subsequent moist desquamation, ulceration, and necrosis may then become apparent. Analgesics, anti‐inflammatories, and antibiotics should be prescribed as indicated and an Elizabethan collar placed to prevent self‐trauma from licking, chewing, etc. Open wound management may be adequate for some patients during the wound‐healing period; however, surgical debridement may be indicated if extensive tissue sloughing occurs (Figure 2.4a and b). It is unknown whether the use of negative pressure wound management may be useful clinically. In severe cases, limb amputation may be required if medical management and local tissue debridement is unsuccessful in addressing the tissue damage. Such an event can be catastrophic for a dog that has already undergone amputation for treatment of osteosarcoma, a tumor type for which doxorubicin is frequently utilized. The goal of early intervention with the above‐outlined protocol is to significantly lessen the severity of the ensuing reaction and to hopefully avoid the need for surgical intervention.