Characteristics and Management of Xylazine-Associated Wounds: A Systematic Review of Published Cases

The rise in xylazine-adulterated fentanyl and heroin has been designated as an emerging public health threat due to a devasting pattern of xylazine- associated wounds associated with its injection. This study was undertaken to systematically characterize patient and wound characteristics, treatment strategy, and outcomes of xylazine-associated wounds reported in the literature.

A systematic review was conducted in December 2025 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and PubMed, Scopus, EMBASE, and Cochrane Review databases were queried. In total, 17 studies were included, describing 277 patients.

The mean age was 39.0 years (±8.38), and 43.0% of the patients were women. Wounds were reported on the upper extremity (83.0%), lower extremity (53.4%), and trunk (0.04%). Of the 275 patients with treatment reported, 14.9% were treated with just local wound care; surgical interventions utilized included irrigation and debridement only (9.8%), skin graft (9.8%) and flap coverage (5.1%); 9.5% of patients required amputation. Discharge against medical advice was reported in 42.2% of cases. Of the published literature, 240 of all cases were published in 2025, and 259 of all cases were reported in Pennsylvania, confirming a growing public health threat with a regional epicenter.

This study reports on the demographic, medical, and social characteristics of patients with xylazine-associated wounds and investigates the wound attributes, treatment strategies, and reported outcomes of affected individuals. Such findings can inform identification, management, and research of xylazine-associated wounds, with the goal to minimize the morbidity of this emerging public health issue.