Hand (New York, N.Y.)
January 18, 2026 · via Europe PMC
Upper Limb Wound Profile in Patients Who Inject Heroin and Fentanyl Mixed With Xylazine.
Dos Santos AK, Sisroe Dos Santos TA, Doddala B, Zabel D.
AI summary — for doctors, generated from the abstract only
Fentanyl/xylazine users had more severe, more often bilateral upper limb wounds than heroin users.
What was studied
Retrospective chart review of 70 patients seen by one plastic surgeon (2019-2023) with opioid-related upper limb soft tissue infections, grouped by heroin vs fentanyl/xylazine use.
Key findings
- Abscess was the most common wound with heroin (50%).
- Full-thickness wounds were most common with fentanyl/xylazine (55%).
- Substance was significantly associated with wound severity, and fentanyl/xylazine had more bilateral injury.
Clinical relevance
Hand surgeons should expect more severe wounds and plan for wound care in xylazine exposure.
Who should care
Limitations
Single private practice with small numbers and no information on treatment outcomes.
Anticipate larger wound burden and bilateral involvement in patients using xylazine-adulterated fentanyl.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Over the last few decades, hand surgeons have described a variety of wounds resulting from opioid use disorder (OUD). In the Philadelphia region, fentanyl mixed with xylazine has risen as a substance of choice. Our primary focus is to report and compare the upper limb wound morphology in patients using fentanyl/xylazine with patients using heroin.
Methods
A retrospective cohort study was performed by reviewing charts of patients seen in consultation in a single plastic surgeon's private practice for upper limb soft tissue infections associated with opioid use from September 1, 2019, to November 30, 2023. Seventy patients were included and stratified based on wound morphology.
Results
We identified 70 patients (36% male, 64% female). In the heroin group, the most common wound was abscess (50%). In the fentanyl/xylazine group, it was full-thickness wound (55%). Chi-square analysis revealed a significant relationship between substance used (heroin or fentanyl/xylazine) and wound severity (mild/moderate or severe), χ2 (1, N = 70) = 42.06, P < .0001.
Conclusions
There is a paucity of medical literature about the spectrum of wound manifestations in OUD. Our data suggests that heroin use more commonly causes unilateral soft tissue injuries, which is likely a result of site-specific infection with intravenous administration. Patients using fentanyl/xylazine had a higher rate of bilateral upper limb injury and presented with more severe wounds than patients who used heroin. Hand surgeons must be informed on the spectrum of wound morphology with OUD and nuances between substances to best manage them in their practice.
DOI
10.1177/15589447251397009
PMID
41549366
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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