Surgical Management of Xylazine-Associated Wounds: A Retrospective Review and Algorithmic Approach

Area of Science:

• Plastic Surgery
• Wound Care
• Public Health

Background:

• Xylazine, a veterinary sedative, is increasingly mixed with illicit fentanyl.
• Subcutaneous xylazine injection causes severe necrotic wounds, recognized as a public health threat.
• Optimal surgical management for these complex wounds remains poorly understood.

Purpose of the Study:

• To review the characteristics and outcomes of xylazine-associated wounds.
• To evaluate different surgical management strategies.
• To develop a treatment algorithm for these complex wounds.

Main Methods:

• Retrospective review of 66 inpatient consultations for xylazine-associated wounds (2018-2023).
• Analysis of wound location, chronicity, infection, and treatment modalities.
• Comparison of healing outcomes based on treatment and continued substance use.

Main Results:

• Wounds commonly occurred on extremities, often chronic and infected (cellulitis, osteomyelitis, sepsis).
• Treatments included local wound care, debridement, skin grafts, and flaps; amputation was required in 9.1%.
• Continued injection was associated with poor healing (20.4% full healing), while cessation led to better outcomes (75.0% full healing).

Conclusions:

• Xylazine-associated wounds present diverse challenges across all body regions.
• Substance use rehabilitation is a critical factor for successful wound healing.
• A staged, multidisciplinary approach guided by an algorithm is recommended for optimal patient care.