The Management of Upper-Extremity Xylazine-Associated Wounds

IF 2.1 2区 医学 Q2 ORTHOPEDICS Journal of Hand Surgery-American Volume Pub Date : 2025-03-01 DOI:10.1016/j.jhsa.2024.11.017
Parker Johnsen MD , Genoveffa R. Morway DO , Aaron Jackson MD , Sara Hope Buchner MD , Pietro Gentile MD , Asif M. Ilyas MD, MBA , Katharine Criner Woozley MD
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Abstract

Purpose

Xylazine has been associated with necrotic soft tissue wounds that have placed a challenging burden on patients who inject drugs in the Philadelphia region’s health care system over the last few years. An analysis of our initial experience is being presented to guide future treatment and directions for future research.

Methods

A retrospective review of 55 patients with patient-reported xylazine use and associated upper-extremity wounds at a single institution was performed. Patient demographics, treatments, and outcomes are presented.

Results

A large percentage of patients with xylazine-associated wounds were homeless (40%), had concomitant psychiatric diagnoses (26%), and had a history of tobacco use (84%). Comorbidities included 5% who were human immunodeficiency virus-positive and 67% who were hepatitis C virus-positive. The median number of hospital admissions per patient for xylazine-associated wounds was 3, with an average of 5.9 (range: 1–44 admissions). The median length of stay per hospital admission was 3 days, with an average of 5.3 days (range: 1–75). Among all included patients, 33 of 55 patients (60%) were treated nonoperatively with local wound care. Of the 22 patients who underwent surgery, there was a surgical complication rate of 59%, primarily related to continued wound issues, infections, and graft failures. The overall rate of patients who left the hospital against medical advice (AMA) was 49%. However, the mortality rate was 0%. Most surgical patients left AMA during their postoperative period hospital stay (64%) and demonstrated continued drug use per review of their hospital records (68%).

Conclusions

Patients presenting with xylazine-associated wounds have a high incidence of homelessness, psychiatric diagnoses, tobacco smoking, hepatitis C virus, and a predilection both toward leaving the hospital AMA and repeated drug use. These variables create inherent challenges to reconstructive surgery, yielding a subsequently high complication rate identified in most surgically managed patients.

Type of study/level of evidence

Therapeutic study IV.
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上肢木嗪相关伤口的处理。
目的:在过去的几年里,在费城地区的卫生保健系统中,Xylazine与坏死性软组织伤口有关,这给注射毒品的患者带来了挑战性的负担。目前正在对我们的初步经验进行分析,以指导未来的治疗和未来的研究方向。方法:回顾性分析同一医院55例报告使用噻嗪并伴有上肢创伤的患者。介绍了患者人口统计、治疗和结果。结果:很大比例的与氯嗪相关的伤口患者无家可归(40%),伴有精神疾病诊断(26%),有烟草使用史(84%)。合并症包括5%的人类免疫缺陷病毒阳性和67%的丙型肝炎病毒阳性。每位患者因xylazine相关伤口住院的中位数为3次,平均5.9次(范围:1-44次)。每次住院的中位住院时间为3天,平均为5.3天(范围:1-75天)。在所有纳入的患者中,55例患者中有33例(60%)采用局部伤口护理非手术治疗。在22例接受手术的患者中,手术并发症发生率为59%,主要与持续的伤口问题、感染和移植物失败有关。不遵医嘱(AMA)而离开医院的总比率为49%。然而,死亡率为0%。大多数手术患者在术后住院期间(64%)离开AMA,并且每次检查他们的医院记录(68%)都显示继续使用药物。结论:二甲肼相关伤口患者有较高的无家可归、精神疾病诊断、吸烟、丙型肝炎病毒、倾向于离开医院和反复用药的发生率。这些变量给重建手术带来了固有的挑战,在大多数手术治疗的患者中产生了随后的高并发症率。研究类型/证据水平:治疗性研究IV。
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来源期刊
CiteScore
3.20
自引率
10.50%
发文量
402
审稿时长
12 weeks
期刊介绍: The Journal of Hand Surgery publishes original, peer-reviewed articles related to the pathophysiology, diagnosis, and treatment of diseases and conditions of the upper extremity; these include both clinical and basic science studies, along with case reports. Special features include Review Articles (including Current Concepts and The Hand Surgery Landscape), Reviews of Books and Media, and Letters to the Editor.
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