Xylazine-Associated Necrotic Upper-Extremity Wounds

Abstract

Background: The rise in xylazine-adulterated heroin and fentanyl poses novel challenges to hand surgeons and a rising epidemic of necrotic upper-extremity wounds. While prior case studies have focused on particularly severe and complex xylazine-associated necrotic (XAN) wounds, the aim of this consecutive case series was to characterize the variability of presentations (ranging from mild to severe) at a single institution at the epicenter of the xylazine epidemic. Methods: Patients presenting to a tertiary referral center for XAN upper-extremity wounds were retrospectively identified from emergency department visits and hospital admissions between January 2021 and December 2023. Patient characteristics, clinical findings, treatment, and hospitalization-related measures were recorded. Wounds were classified according to the depth, density, size, and presence of osteomyelitis. All of the variables were quantified using descriptive statistics. Results: In total, 82 patients with 125 XAN wounds were included in the study. The mean age was 40.3 ± 8.2 years, and 57% of the patients were men. Of the 125 wounds, 54% had associated osteomyelitis, 78% were confluent, and 47%involved more than two-thirds of the anatomic region. Surgery was recommended for 78% of the patients and was performed in 62%, with 13% undergoing amputation. Complications rates were high (77%) and included bacteremia (40%) and death (5%). Patients were hospitalized a mean of 4.1 times and were discharged against medical advice 2.8 times per year. Conclusions: This study presents a broad perspective on demographic, social, and medical factors in patients with XAN wounds of the upper extremity. Given the complexity and burden of this public health crisis, early intervention is important to prevent complications and mitigate costs. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.