"Xylazine (also known as “tranq, tranq dope, Philly dope, sleep-cut, or zombie drug”) is a non-opioid veterinary tranquilizer that has become a common additive with illicit fentanyl and other opioids.1 When xylazine is injected with fentanyl, the result can be severe soft tissue injury ranging from superficial irritation to deep tissue necrosis and even bony involvement (Fig. 1). The pathogenesis of the skin changes from xylazine is multifactorial but most akin to a burn from local tissue injury. Theoretical causes for the tissue toxicity from xylazine include injury from the concentrated acidity, the vasoconstrictive effect on local blood vessels, and overall decreased tissue oxygenation from central nervous tissue depression.2 However, the enhanced and prolonged euphoric effect xylazine adds to injected fentanyl will likely only increase the potential for abuse."
Tosti R, Hozack BA, Tulipan JE, Criner-Woozley KT, Ilyas AM. Xylazine-Associated Wounds of the Upper Extremity: Evaluation and Algorithmic Surgical Strategy. J Hand Surg Glob Online. 2024;6(5):605-609. Published 2024 Jun 19. doi:10.1016/j.jhsg.2024.05.003
