Background: Injectable drug use (IDU) is a public health issue in the United States. Xylazine, a veterinary tranquilizer, is found added to illicit fentanyl due to its prolonged sedative effects. Xylazine has also been thought to cause wounds due to its vasoconstriction effects. In this study, we examined the population of these patients at our urban academic center to better identify demographics, wound characteristics, and management strategies. Methods: Patients presenting to our institution’s emergency department (ED) from January 2017 to December 2024 with a wound related to xylazine use were retrospectively identified using EMERSE, a full-text EMR search engine. Demographics, comorbidities, social history, and wound characteristics were analyzed. Wound photographs were examined for location, size, and severity. Treatment and operative intervention were reviewed. Results: We identified 74 patients with 241 wounds secondary to xylazine use. The mean age was 41.2 years old. Patients were more likely to be female (58.1%) and white (93.2%). The average number of ED visits for wound related complaints was 5.5 (range 1-52) and 52.7% of patients left against medical advice during a visit. The most common comorbidities were hepatitis C (82.4%), hepatitis B (23.0%), endocarditis (23.0%), osteomyelitis (20.3%), and HIV (10.8%). A majority (69.0%) of patients had a psychiatric diagnosis (40% generalized anxiety disorder, 40% major depressive disorder, 9% PTSD). Active IDU was reported in 86.9% and tobacco use in 78.6% of patients. 27% of patients reported being unhoused. The most common wound sites were the anterior lower leg and dorsal forearm. 17.6% of patients had exposed bone or tendon. 41.1% of wounds were less than 1 cm2, 37.3% were between 1 cm2 and 1% total body surface area (TBSA), and 21.6% were >1% TBSA. Plastic or hand surgery was consulted on 43.2% of patients. Most received antibiotics (79.7%) and/or wound care (81.8%). Debridement occurred in 44.0% of patients and 5.4% of patients underwent surgery. Conclusion: This study characterizes the largest reported cohort of patients suffering from xylazine-associated wounds. Patients were typically of low socioeconomic status and were more often female and white. They often represented to the ED multiple times, had complex comorbiditie, and required expert consultation. Wounds varied in size, location, and depth but were commonly on extremity extensor surfaces. Treatment primarily included antibiotics and wound care, though debridement and surgery were sometimes required. IDU is common in today’s world, and it is imperative for plastic surgeons to have a treatment algorithm in mind when they are consulted for xylazine-associated wounds.