Upper Limb Wound Profile in Patients Who Inject Heroin and Fentanyl Mixed With Xylazine

Area of Science:

• Plastic Surgery
• Hand Surgery
• Dermatology

Background:

• Opioid use disorder (OUD) is associated with diverse upper limb wounds.
• Fentanyl mixed with xylazine is increasingly prevalent in the Philadelphia region.
• Understanding wound morphology differences based on substance is crucial.

Purpose of the Study:

• To compare upper limb wound morphology in patients using fentanyl/xylazine versus heroin.
• To highlight the spectrum of wound manifestations in OUD.

Main Methods:

• Retrospective cohort study of 70 patients with upper limb soft tissue infections linked to opioid use.
• Patients stratified by wound morphology and substance used (heroin vs. fentanyl/xylazine).
• Data collected from September 2019 to November 2023.

Main Results:

• Heroin users most commonly presented with abscesses (50%).
• Fentanyl/xylazine users predominantly had full-thickness wounds (55%).
• A significant relationship exists between substance used and wound severity (P < .0001).

Conclusions:

• Fentanyl/xylazine use is linked to more severe, bilateral upper limb injuries.
• Heroin use typically results in unilateral soft tissue injuries, often abscesses.
• Hand surgeons need awareness of OUD-related wound variations for effective management.