Upper Extremity Soft Tissue Wound Related to Xylazine-laced Fentanyl Intravenous (IV) Drug Abuse: A Case Report

Abstract

A 35-year-old male abusing intravenous (IV) xylazine-laced fentanyl presented with bilateral forearm wounds. His wounds extended from the wrist to the proximal forearm with exposed muscles and tendons. He was treated with intravenous antibiotics, multiple surgical debridements, and negative pressure wound therapy. He left against medical advice (AMA) and returned with similar, smaller wounds nine months later. The patient was treated and again left AMA and has not followed up since. Xylazine is a veterinary tranquilizer often added to fentanyl to prolong and enhance its effects, whose presence has markedly increased in the illicit drug markets in the United States. It can result in extensive tissue loss from direct toxicity of the drug and/or concomitant infection. Xylazine use may increase morbidity in persons who inject drugs relating to the high prevalence of skin ulcers, soft tissue abscesses, and risk of serious infection necessitating surgical management.