Xylazine-Associated Wounds: A Scoping Review of Clinical Presentation and Management

Xylazine-adulterated opioids have led to an increase in xylazine-associated wounds (XAWs) among people who use drugs. This scoping review synthesizes current information on the clinical presentation and management of XAWs.

Investigators searched PubMed and Scopus for English-language articles on the clinical presentation or management of XAWs.

Exclusion criteria included non-English articles, wounds not associated with xylazine, lack of clinical presentation or management information, brief communications, and review articles. Of 2711 articles screened, 10 met the inclusion criteria.

Extracted data included patient characteristics, clinical presentation, and medical or surgical management.

Among 22 patients, wounds initially presented at and/or away from injection sites as dark blisters with irregular borders, then evolved into dry, adherent eschar; some wounds progressed to deeper ulcers with intact skin islands. Eight of the 10 studies reported at least 1 case of superinfection, with the most common being periwound cellulitis or abscess. Infection-control measures included debridement, wound-bed preparation, moisture control with appropriate dressings, cultures, consistent documentation of wound changes, and hand hygiene. Nonhealing wounds required further surgical interventions such as debridement (n=4), upper extremity amputation (n=3), or microvascular flap coverage (n=1). Only 2 patients fully recovered; the remainder were lost to follow-up.

Xylazine-associated wounds necessitate multidisciplinary care strategies that prioritize wound care, harm reduction, and comprehensive withdrawal management to address both the physical and psychosocial needs of people who use drugs.