wound on addict's forearm caused by fentanyl cut with the drug xylazine.

A 35-year-old male presented to the emergency department with bilateral forearm wounds. His past medical history was significant for untreated hepatitis C. He was unemployed and homeless. He reported injecting xylazine-laced fentanyl into his bilateral forearms. A physical exam revealed bilateral full-thickness skin wounds from the wrist to the proximal forearm over the ulnar border measuring [Figure 1]. The wounds appeared cavernous with undulated regions of eschar. Further, examination revealed exposed muscle and tendon bilaterally and some exposed muscle of the dorsal forearm compartments. His hand function was preserved.

The patient was admitted to the hospitalist and initiated on broad antibiotic treatment with intravenous vancomycin and piperacillin/tazobactam. His wounds were washed and covered at the bedside, and he underwent surgical debridement in the operating room the following day. Intraoperatively, the eschar layers were removed sharply with a knife until a bleeding surface was encountered. Exposed muscle layers were removed with a curette. The ulna had an intact periosteum. Large-volume irrigation was used to clean the wounds. A negative pressure wound therapy device was fitted to the bilateral forearms. The sponge was changed twice over six days. On a postoperative day seven, the patient was returned to the operating room. Granulation tissue was observed over the ulna, and the wounds appeared clean. The surgeon covered the area with a split-thickness skin graft taken from the thigh. A negative pressure wound dressing was placed over the skin graft. The patient left the hospital against medical advice (AMA) two days following the second surgery and did not follow up in the surgeon's office.

Approximately nine months later, the patient returned to the emergency room with a similar, smaller wound on the left forearm. On exam, both previous skin grafts had healed well, and the new wound was adjacent to the volar border of the skin graft and measured 8x4cm. The wound exhibited a cavernous appearance but did not have exposed muscle. The next day, surgical debridement was performed, followed by negative pressure wound therapy. The day after surgery, the patient left AMA with no follow-up reported since.

https://surgicoll.scholasticahq.com/article/71308-upper-extremity-soft-tissue-wound-related-to-xylazine-laced-fentanyl-intravenous-iv-drug-abuse-a-case-report