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

Abstract

Objective: 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.

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

Study selection: 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.

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

Data synthesis: 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.

Conclusions: 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.

Keywords: necrosis; substance use disorder; tranquilizer; wound care; xylazine.