Wound Care

The increasing use of xylazine as an adulterant in the fentanyl supply has given rise to a unique and severe type of wound. Xylazine-associated wounds most commonly occur at a site of injection but have been described to develop in other areas of the body, even when xylazine exposure is through means other than injection. If left untreated, these wounds can lead to extensive tissue damage and systemic complications. 

For Health Care Providers 

Health care providers play a pivotal role in addressing and managing xylazine-related wounds. This includes: 

Identification and Diagnosis 

Familiarity with the characteristic appearance of xylazine wounds—ulcerative, necrotic, found on extensor surfaces of extremities, and often resistant to healing—is essential. 
Providers should perform thorough wound assessments, evaluating the extent of tissue damage including surface area and depth, and look for signs of co-occurring infections such as cellulitis, abscess formation, or systemic involvement (e.g., sepsis). 

Management 

Treatment:

Conservative wound care management is typically recommended. Xylazine-associated wounds despite the severity retain good healing properties with regular conservative wound care and adequate nutrition.  

Wound Debridement:

Necrotic or infected tissue may require debridement. Conservative wound autolytic debridement is typically preferred over aggressive surgical debridement unless there are concerns for deep space infection. Avoiding repeated surgical debridement can prevent unnecessary tissue loss that may lead to amputation. 

Wound Dressing:

Wounds should be kept moist and covered to allow for optimal healing. Eschar (scabs) trap infection and prevent healing. Wounds should be cleaned with soap and water daily to keep bio burden to a minimum. Ointments should be applied to keep wounds moist and prevent bacterial overgrowth including silver sulfadiazine or A & D ointment. A non-adherent dressing should be utilized to avoid the dressing from drying to the surface of the wound as this will lead to painful dressing changes. An absorptive pad should be utilized for wounds with significant drainage and a cohesive or elastic wrap should be used to keep the dressing in place.  

Antibiotics:

Xylazine-associated wounds often present with significant superficial bacterial overgrowth which is typically managed with topical treatments. Systemic antibiotics are typically reserved for wounds associated with significant surrounding cellulitis or systemic signs of infection. 

Pain Management:

Patients often suffer from significant pain related to their wounds. Multimodal pain management is necessary to allow for adequate wound care. 

Referrals:

While conservative management of xylazine-associated wounds can typically take place in a primary care or addiction medicine office, severe cases may warrant referral to specialized wound care services including plastic or burn surgery. 

WOUND CARE BASICS

Education and Prevention 

It’s crucial to educate patients on properly cleaning and dressing wounds.

Harm reduction practices, such as transitioning method of use from injection to other routes, avoiding injecting into the wound, using sterile equipment, and engaging with syringe service programs are also important in preventing further wounds. 

Promoting comprehensive care that integrates treatment for substance use disorder alongside wound management is also critical. Patients can and do successfully manage day to day wound care on their own when provided with the proper resources and education. (see below) 

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For Those With a Xylazine-Associated Wound

Self-management of xylazine-associated wounds is critical to recovery. Key practices for successful wound management include:

◉ Daily cleaning with mild soap and water or wound cleansers to remove debris and superficial bacteria. 
◉ Applying appropriate ointments and dressings to promote a moist healing environment. 
◉ Avoiding injecting directly into the healing wound.
◉ Monitoring for signs of infection and knowing when to seek medical care.

Signs of infection include: 

◉ Redness, warmth, or swelling around the wound. 
◉ Increased pain or tenderness. 
◉ Discharge of pus or foul-smelling drainage. 
◉ Fever, chills, or other systemic symptoms. 

When Should a Provider Assess and Treat a Wound? 

While minor wounds may be managed at home, medical evaluation is critical when: 

◉ Wounds are large, deep, or not improving with self-care. 
◉ Signs of infection are present. 
◉ There is significant necrosis or exposure of underlying structures. 
◉ If the person with a wound has other conditions such as diabetes, peripheral vascular disease, or immunosuppression. 

Community Resources and Support 

Healthcare systems, clinics, community groups, and individuals using drugs are encouraged to partner with their local harm reduction centers. Many harm reduction centers provide wound care services as well as safer use kits. Organizations and community groups can work with the SNJMATCOE to increase their capacity to manage xylazine-associated wounds in their settings. In addition, organizations can directly refer patients to Cooper’s Center for Healing for outpatient or inpatient care.

Outpatient management: patients receive wound care treatment as well as wound care education and essential wound care kits, including dressings, cleansers, and instructions for use.

ED/In-patient management: During an in-patient stay within Cooper, patients will receive care from our Addiction consult team to ensure that while receiving antibiotics they have access to multimodal (comprehensive) pain management and withdrawal prevention.

For more information or to get involved, reach out to SNJMATCOE for training, resources, and support in delivering effective wound care to at-risk populations.