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Xylazine-Associated Wounds of the Upper Extremity: Evaluation and Algorithmic Surgical Strategy
Journal article   Open access   Peer reviewed

Xylazine-Associated Wounds of the Upper Extremity: Evaluation and Algorithmic Surgical Strategy

Richard Tosti, Bryan A. Hozack, Jacob E. Tulipan, Katherine T. Criner-Woozley and Asif M. Ilyas
Journal of hand surgery global online, pp 100852-100852
Nov 2025
DOI: https://doi.org/10.1016/j.jhsg.2025.100852
url
https://doi.org/10.1016/j.jhsg.2025.100852View
Published, Version of Record (VoR) Open

Abstract

Hand Surgical strategy Upper extremity Xylazine Xylazine-associated wounds
The coadministration of xylazine, a veterinary tranquilizer, with illicit fentanyl has led to severe soft tissue injuries, ranging from superficial irritation to deep tissue necrosis and even bone involvement, because of multifactorial tissue toxicity. Despite its non-opioid nature, xylazine enhances and prolongs the euphoric effects of fentanyl, exacerbating the potential for abuse. The pathogenesis of the tissue damage from xylazine is multifactorial but most akin to a burn from local tissue injury. With illicit opioids increasingly adulterated with xylazine, particularly in urban areas like Philadelphia, the prevalence of associated wounds, especially in the upper extremities, is anticipated to rise. Managing these wounds demands a multidisciplinary approach, with hand surgeons and reconstructive surgeons playing a central role. This review summarizes the historical context, pharmacodynamics, initial evaluation, wound categorization, algorithmic treatment, and expected outcomes of xylazine-associated wounds.

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