Case Report: Delayed epirubicin extravasation-induced ulceration in a dog managed without surgical intervention using adjunctive hyperbaric gaseous cryotherapy

Extravasation of anthracyclines can result in progressive tissue injury, ulceration, and necrosis, and may ultimately require surgical intervention. Management of delayed presentations remains challenging, as recommended treatments, including dexrazoxane, dimethyl sulfoxide (DMSO), and cold compresses, are most effective when initiated promptly after the extravasation event. A 9-year-old spayed female Poodle with suspected stage IV multicentric lymphoma developed a progressive ulcerative lesion 17 days after suspected epirubicin extravasation, by which time the recommended treatment window for standard interventions had elapsed. Given the progressive ulceration, severity of tissue injury, and delayed presentation, surgical debridement was considered. However, conservative management was pursued owing to the patient’s limited prognosis and the owner’s preference to prioritize quality of life. Treatment included hyperbaric gaseous cryotherapy (HGC) as the principal adjunctive modality, based on prior clinical experience in wound management and pain control. Dexrazoxane, topical DMSO, and ice-pack application were also incorporated despite the elapsed therapeutic window, as few alternative treatment options remained at that stage. Progressive wound healing was observed over the course of treatment, with complete re-epithelialization achieved by day 93 without surgical intervention. The wound remained fully healed until the patient died of progressive lymphoma on day 138. This case documents complete wound resolution without surgery in a dog with delayed epirubicin extravasation managed with multimodal conservative treatment incorporating adjunctive HGC.