(CS-113) Fragmented Fish Skin Graft to Heal Wounds Due to “Tranq” Injections

Xylazine is a large-animal tranquilizer that causes severe central nervous system (CNS) depression. When mixed with heroin, it’s referred to as “tranq.” It’s sedative, analgesic, and muscle-relaxant properties are why it’s lately added to heroin, to enhance CNS depression causing a “zombie-like” state. This allows traffickers to decrease the amount of heroin in a sample, to maximize profits while still producing the desired effect. Common complications include severe hypotension and bradycardia, and less often apnea requiring intubation and even death. (1-3)

Infections and wounds are common amongst narcotics injectors; however, xylazine-related wounds carry unique characteristics resulting in increased morbidity. These wounds are often independent of injection sites, but are in their periphery. They initially present as diffuse punched-out lesions with a granular base and central necrosis, which, if left untreated spread circumferentially to from much larger wounds (often greater than 10 cm in diameter).  Clinically they appear similar to burn wounds. (4) If the wounds are further neglected then osteomyelitis may develop, warranting amputation. A 2022 case report presented a 37-year-old female who injected xylazine developed spontaneous, large leg wounds with evidence of osteomyelitis within 1–2 weeks of onset. (5)

Methods:

The wounds were debrided and noted to be deep to tendon/muscle. Fragmented Fish skin graft*(FSG) was then packed into the wound cavities, after which sterilized honey* was applied. On outpatient visits, sterilized honey was applied again. Patient was instructed to apply sterilized honey onto his wounds every other day when performing dressing changes.

Results:

At the first post operative visit, the complete depths of the wounds had granulated in. The wounds were completely healed at two months post operation.

Discussion:

Wounds secondary to “tranq” injections deteriorate rapidly, therefore it was decided to intervene on this patient the day of presentation. The results seen after only a single debridement and application of FSG/sterilized honey proved to be extremely effective, and can be applied wherever on the body xylazine-related ulcers are encountered. Replication of this specific treatment is needed anywhere on the body these atypical ulcerations are encountered, to solidify it as a standard of care.