Provide effective analgesia or anesthesia (see K9 Analgesia and Anesthesia) based on wound severity, location and other factors. See Table 1.^1-7

1. The goal of initial lavage is to remove gross contaminants and reduce bacterial burden.

• Apply sterile water-soluble lubricant liberally on the wound bed and then clip the hair with wide margins around the wound.
• Gently cleanse the skin around the wound, but not the wound bed, with surgical scrub (such as chlorhexidine gluconate or povidone-iodine).
• Gently lavage the lubricant and gross contaminants from the wound using a sterile isotonic solution (such as normal saline or Lactated Ringer’s Solution). Tap water can also be used in austere conditions for wound lavage to remove debris when saline or LRS is not available, as studies have shown no increase in wound infection rate when compared to saline.⁸

2. Debride grossly necrotic tissue and non-viable tissue (see Figure 1) carefully using aseptic technique and sharp dissection with a scalpel blade or scissors. Do not mass ligate tissues or use excessive cautery – this leads to necrosis. Use caution not to damage, transect, or ligate major blood vessels (unless active hemorrhage) or nerves.