Back to 2025 Abstracts
Surgical Management of Xylazine-Associated Wounds: A Retrospective Review and Algorithmic Approach.
Alan T. Makhoul
*1, Carrie Morales
1, Elizabeth Card
1, Matthew Goldshore
2, Jon B. Morris
3, L S. Levin
4, Jason Wink
1, John P. Fischer
1, Ines C. Lin
1, Stephen J. Kovach
11Plastic Surgery, University of Pennsylvania, Philadelphia, PA; 2Surgery, Children's Hospital of Philadelphia, Philadelphia, PA; 3Surgery, University of Pennsylvania, Philadelphia, PA; 4Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
Background: Xylazine is veterinary sedative that is increasingly added to illicit fentanyl to prolong its euphoric effects. The northeastern U.S. is the epicenter of use. When injected subcutaneously, xylazine causes large, necrotic wounds. To date, the optimal surgical management of these wounds is not well understood.
Methods: All plastic surgery consultations for xylazine-associated wounds at an academic medical center in the northeastern U.S. between 2018 and 2023 were reviewed. Following IRB exemption, charts were identified through report generation in Epic Systems. Categorical variables were compared using Fisher's exact test with significance set at p < .05.
Results: 66 patients were seen. Wounds were located on the arm/forearm (54.5%), lower extremity (47.0%), hand (33.3%), neck (7.6%), chest (3.0%), and abdomen (1.5%). 69.7% presented with a chronic wound (>3 months). 24.2% of wounds involved deep structures: bone (n=13), airway (n=2), neurovasculature (n=1). 80.3% injected drugs within 24 hours of presentation. Treatment modalities included: local wound care only (45.5%), surgical debridement only (22.7%), skin grafting (19.7%), skin substitute (10.6%), local tissue rearrangement (3.0%), free flap (3.0%), and amputation (9.1%). 73.8% continued to inject drugs after initial treatment, 13.8% stopped injecting, and 13.8% were lost to follow-up. By study completion, 25.8% fully healed their wound, and 27.3% partially healed. Among those who continued to inject, 20.4% (9/44) fully healed, compared to 75.0% (6/8) of those who stopped (p = .0048). 13.0% (3/23) treated with wound care fully healed, compared to 21.4% (3/14) of those treated with debridement (p = .65). Reconstructive efforts were successful in 50% of cases (7/14).
Conclusion: Xylazine-associated wounds are an emerging public health threat. Local wound care is fundamental, and a staged reconstructive approach is preferred. Substance use rehabilitation is associated with successful healing. An algorithm for multidisciplinary management is beneficial for standardizing care.
Figure 1: Treatment algorithm for the surgical management of xylazine-associated wounds.
Back to 2025 Abstracts
