Necrotic Upper-Extremity Infections in People Who Inject Drugs: A Case Series

Area of Science:

• Infectious Diseases
• Toxicology
• Trauma Surgery

Background:

• An increase in severe upper-extremity infections requiring transhumeral amputation has been observed.
• These infections disproportionately affect individuals who inject drugs.
• The presence of xylazine in injectable drugs is a potential contributing factor.

Purpose of the Study:

• To demonstrate the severe outcomes of upper-extremity infections in people who inject drugs.
• To explore the potential link between xylazine adulteration in injectable drugs and these severe infections.
• To highlight the need for further investigation into xylazine's role in tissue necrosis.

Main Methods:

• Retrospective case series of patients undergoing transhumeral amputation due to severe upper-extremity infections.
• Study period: January 1, 2020, to September 30, 2022.
• Data collected via chart review and clinical images at a single urban level 1 trauma center.

Main Results:

• Eight patients presented with extensive skin and soft tissue necrosis, exposing the radius and ulna.
• All patients had a complete loss of hand motor function and sensation.
• All patients required transhumeral amputations; one patient underwent bilateral amputations.

Conclusions:

• Patients reported injecting drugs containing tranquilizers, with xylazine detected in 91% of local heroin and fentanyl samples.
• The severity of tissue necrosis suggests a significant role for xylazine, though further studies are needed.
• The findings are concerning given the potential spread of xylazine-adulterated drugs to other regions.