Xylazine-Associated Necrotic Upper-Extremity Wounds: A Single Hospital System's Experience with 82 Patients and 125 Wounds.

IF 4.4 1区医学 Q1 ORTHOPEDICS Journal of Bone and Joint Surgery, American Volume Pub Date : 2024-12-23 DOI:10.2106/JBJS.24.00534

Sebastian D Arango, Jason C Flynn, Jacob H Zeitlin, Tristan B Weir, Andrew J Miller

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Abstract

Background: The rise in xylazine-adulterated heroin and fentanyl poses novel challenges to hand surgeons and a rising epidemic of necrotic upper-extremity wounds. While prior case studies have focused on particularly severe and complex xylazine-associated necrotic (XAN) wounds, the aim of this consecutive case series was to characterize the variability of presentations (ranging from mild to severe) at a single institution at the epicenter of the xylazine epidemic.

Methods: Patients presenting to a tertiary referral center for XAN upper-extremity wounds were retrospectively identified from emergency department visits and hospital admissions between January 2021 and December 2023. Patient characteristics, clinical findings, treatment, and hospitalization-related measures were recorded. Wounds were classified according to the depth, density, size, and presence of osteomyelitis. All of the variables were quantified using descriptive statistics.

Results: In total, 82 patients with 125 XAN wounds were included in the study. The mean age was 40.3 ± 8.2 years, and 57% of the patients were men. Of the 125 wounds, 54% had associated osteomyelitis, 78% were confluent, and 47%involved more than two-thirds of the anatomic region. Surgery was recommended for 78% of the patients and was performed in 62%, with 13% undergoing amputation. Complications rates were high (77%) and included bacteremia (40%) and death (5%). Patients were hospitalized a mean of 4.1 times and were discharged against medical advice 2.8 times per year.

Conclusions: This study presents a broad perspective on demographic, social, and medical factors in patients with XAN wounds of the upper extremity. Given the complexity and burden of this public health crisis, early intervention is important to prevent complications and mitigate costs.

Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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二甲嗪相关的上肢坏死伤口：单一医院系统82例患者125处伤口的经验。

背景：掺杂氯嗪的海洛因和芬太尼的增加给手外科医生带来了新的挑战，并且上肢坏死伤口的流行率也在上升。虽然以前的病例研究集中在特别严重和复杂的木嗪相关坏死（XAN）伤口上，但本连续病例系列的目的是表征在木嗪流行中心的单一机构中表现的可变性（从轻度到重度）。方法：回顾性分析2021年1月至2023年12月期间，在三级转诊中心就诊的XAN上肢伤口患者的急诊和住院情况。记录患者特征、临床表现、治疗和住院相关措施。根据伤口的深度、密度、大小和是否存在骨髓炎进行分类。所有变量均采用描述性统计进行量化。结果：共纳入82例125例XAN伤口患者。平均年龄40.3±8.2岁，男性占57%。在125例伤口中，54%伴有骨髓炎，78%为融合性，47%累及超过三分之二的解剖区域。78%的患者建议手术治疗，62%的患者接受手术治疗，13%的患者接受截肢治疗。并发症发生率高（77%），包括菌血症（40%）和死亡（5%）。患者平均每年住院4.1次，不遵医嘱出院2.8次。结论：本研究为上肢XAN创伤患者的人口统计学、社会和医学因素提供了广阔的视角。鉴于这一公共卫生危机的复杂性和负担，早期干预对于预防并发症和降低成本至关重要。证据等级：治疗性IV级。参见《作者说明》获得证据等级的完整描述。

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来源期刊

Journal of Bone and Joint Surgery, American Volume 医学-外科

CiteScore

8.90

自引率

7.50%

发文量

660

审稿时长

1 months

期刊介绍： The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.