Upper Limb Wound Profile in Patients Who Inject Heroin and Fentanyl Mixed With Xylazine

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), χ 2 (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.