TABLE 1.

The Prevention Point Philadelphia Wound Care Clinic’s Approach to Care for Xylazine-associated Wounds

Stepwise Dressing Change	Dressing Products Used	Notes
Step 1: Premedicate if possible		In settings where available, advocate for adequate pain/withdrawal management before dressing change
Step 2: Remove soiled dressing		Soak soiled dressing with water/saline to decrease pain with removal. Offer patient option to remove their own dressing.
Step 3: Clean	Normal saline, generic wound washes For wounds with heavy burden of nonviable tissue: • Vashe, Dakins 0.125%	Test cleansers on small area of wound to assess tolerance.
Step 4: Debride	Enzymatic debridement • Santyl: Requires prescription; costly Autolytic: • Medihoney: Consider outdoor exposure and potential insect attraction • Hydrogel silver • Silver gel/Silver sulfadiazine • PHMB topical	Topicals may be applied to the primary dressing (step 6) to avoid directly touching sensitive wounds. Alert patient to the likelihood of increased drainage with use of topical debriding agents. Cross-hatching of eschar, if tolerated, promotes deeper penetration of topical debriding agents and may be appropriate in some settings.
Step 5: Apply other topicals	Skin protectant to periwound tissue (eg no-sting skin prep, A&D ointment, Coloplast Triad) Topical antibiotic if indicated and compatible (eg, Mupirocin)	Preservation of intact periwound tissue is priority, especially with necrotic and heavily exudative wounds. Systemic antibiotics do not penetrate above the wound bed, and a topical may be required to reduce the overall bioburden.
Step 6: Apply primary dressing	Based on assessment of wound drainage: • Wet/normal wound: Oil-emulsion (e.g. Adaptic) • Dry wound: Petroleum-based (e.g. Xeroform)	Cut to shape of wound to avoid coverage of periwound area, which can promote breakdown. Check compatibility of Xeroform and any topicals used.
Step 7: Apply secondary of dressing	Super absorbent dressing, layers of woven gauze, abdominal pads, or nonstick gauze
Step 8: Secure	Gauze wrap secured with Tubigrip, IV netting, self-adherent wrap, or ACE bandage	Self-adherent or ACE bandages should be applied just tight enough to secure underlying dressings, not for compression. Self-adherent wrap may contribute to skin breakdown if not changed daily.
Harm reduction and trauma-informed care considerations
• Assess the patient’s history of wound care—what dressing supplies or strategies have and have not worked? • Ask if patient would like to remove dressing themselves, to support engagement and autonomy and minimize pain. • Recognize the distress and stigma often associated with wound odor—offer air freshener, aromatherapy inhalers, and change trash frequently. • Dispense oral antibiotics or other oral medications in lanyard-attached container (eg, clear plastic badge holder) to prevent theft or loss (for unhoused individuals) • Establish a wound dressing change schedule that is feasible for patient – provide dressing change supplies to accommodate several dressing changes when possible. • Build relationships with local emergency medicine, internal medicine, infection disease and addiction medicine departments to facilitate warm handoffs of patients to and from hospitals