Xylazine Associated Wounds: An Emerging Epidemic

Introduction: Over the past few years, the opioid crisis has seen a new and dangerous additive in the fentanyl community; the veterinary sedative, xylazine, also known as tranq. While the etiology of xylazine-associated skin necrosis is not well understood yet, these wounds are becoming more prevalent in our community and carry increased risk of bacteremia, amputations, and death. As this is a new and distinct wound category, much remains unknown about the best treatment plan for these complex wounds in patients that often have significant barriers to care. Outpatient and inpatient care can be hindered by opioid withdrawal, unmanaged pain, and previous poor experiences in the hospital setting related to feelings of stigmatization. Our goal is to maximize healing opportunities.Methods:As there is no current standard of care, we describe a prospective treatment modality instituted by our facility. Conservative treatment using a combination of pure hypochlorous acid-based wound cleanser* (pHA) and topical debridement (both enzymatic∞ and autolytic±), has been beneficial prior to surgery, as an alternative to surgical intervention, and as an ongoing treatment to help decrease bioburden, remove necrotic tissue, and maintain a pH that mimics human skin to support epithelialization and angiogenesis.Results:Eight patients, in their twenties to forties, had extensive Xylazine-associated wounds involving their extremities. These were full thickness involving soft tissue, muscle, tendons, and bone, yet they were successfully managed with pHA combined with topical debridement, promoting healing. This novel approach enabled patients to tolerate wound care with significantly less pain than alternative treatment modalities requiring frequent removal of products, thereby exacerbating the wounds. This treatment allowed for limb salvage in most of these patients. No adverse events, such as bleeding or reactions were noted.Discussion: These dressing changes are less frequent and less painful, facilitating patient/caregiver trust which encourages patients to remain inpatient longer to promote healing. This wound care regimen is easily taught and can help patients prevent readmissions for grossly infected soft tissue wounds. As more of these patients are seen, continued surveillance will provide more insight into the effectiveness of this treatment modality.References:Gupta R, Holtgrave DR, Ashburn MA. Xylazine - Medical and Public Health Imperatives. N Engl J Med. 2023;388(24):2209-2212. doi:10.1056/NEJMp2303120 Guidelines For Xylazine-Associated Wounds. Temple Health. November, 2023. FY24-1162. Accessed May 30, 2024. McFadden R, Wallace-Keeshen S, Petrillo Straub K, et al. Xylazine-associated Wounds: Clinical Experience From a Low-barrier Wound Care Clinic in Philadelphia. J Addict Med. 2024;18(1):9-12. doi:10.1097/ADM.0000000000001245 Philadelphia Department of Public Health, Division of Substance Use Prevention and Harm Reduction. Recommendations for caring for individuals with xylazine-associated wounds. January, 8th, 2024.