Authors recently examined a series of their own cases alongside others reported in the literature to attempt to gain some insight into optimizing treatment for xylazine-related soft tissue necrosis.¹ As an emerging threat to public health, illicit injection of xylazine can carry significant repercussions, including risk of limb amputation. The researchers reported on 7 cases from their experience, specifically with upper extremity soft tissue necrosis secondary to xylazine injection.¹ They also summarized notable findings from 13 more cases derived from 5 separate studies. Analyzing metrics such as treatment strategy and outcomes, they shared case details and lessons learned for possible application in practice.¹

Management pathways for the cases discussed included local wound care, soft tissue reconstruction, osseous reconstruction, and amputation.1 The concluded that prompt, acute treatment for soft tissue necrosis related to xylazine injection is ideal. In order to best prevent complications and pursue limb preservation, the authors contend that clinicians should consider the depth of the tissue involvement. Outlining 4 stages, the authors shared the following pathways using this point of view¹:

Stage 1 – superficial ulceration of skin and subcutaneous tissue. Management may be appropriate with local wound care.

Stage 2 – deeper ulceration involving muscle and/or tendon. Management may require soft tissue reconstruction and surgical debridement. 

Stage 3 – deeper ulceration involving bone. Management may require osseous debridement and bony reconstruction. 

Stage 4 – involving all tissues in the extremity. Management may often require amputation.

This proposed algorithm for management may potentially give providers more information on pathways to consider when dealing with these complex and aggressive cases.

Reference