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Assessing the Impact of Xylazine Intravenous Abuse: An In-Depth Case Series and Evaluation of Existing Hand SurgeryTreatment Strategies
Sebastian D Arango, B.S.
1; Jason C. Flynn, B.S.
2; Jacob Zeitlin, B.A.
3; Tristan B. Weir, M.D.
4; Andrew J. Miller, M.D.
41Philadelphia Hand to Shoulder Center - Thomas Jefferson University, Philadelphia, PA; 2Sidney Kimmel Medical College, Philadelphia, PA; 3Weill Cornell Medical College, New York, NY; 4Philadelphia Hand to Shoulder Center, Philadelphia, PA
Introduction: 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 severe and complex xylazine-associated 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 center of the xylazine epidemic.
Materials & Methods: Patients presenting to a tertiary referral center for necrotic 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 hospital-reported outcomes were recorded. Wounds were classified according to the depth, density, size, and presence of osteomyelitis. All variables were quantified using descriptive statistics.
Results: In total, 82 patients with 125 xylazine-associated necrotic wounds were included. The mean age was 40.3 ± 8.2 years and 57% were male. 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 in 78% and performed in 62% of patients, with 13% undergoing amputations. Complications rates were high (77%) and included bacteremia (40%) and death (5%). Average longest hospital length of stay during the study period was 21.1 ± 26.4 days. Patients were hospitalized a mean of 4.1 times and discharged against medical advice 2.8 times per year.
Conclusions: This study presents a broad perspective of demographic, social, and medical factors in patients with xylazine-associated necrotic 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.
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