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Current wound classification systems fail to address the unique features of this injury, creating a need for a tailored assessment and treatment approach. We developed the HEAL\u2010X classification system to standardise evaluation and treatment of xylazine\u2010associated wounds. The system grades wounds using five criteria: History, Extent, Appearance, Location, and Xylazine\u2010specific features. Grades range from 0 (normal skin) to 5 (underlying structure involvement). HEAL\u2010X integrates principles from existing classifications while focusing on xylazine\u2010specific pathology. This novel system was developed by an inter\u2010disciplinary panel and requires empirical validation through clinical application and further research. HEAL\u2010X provides a framework for grading xylazine\u2010associated wounds, guiding treatment from lower\u2010grade wounds to severe cases. This system aligns with the unique characteristics of xylazine wounds, offering a more tailored approach than any existing models individually. HEAL\u2010X addresses a critical gap in managing xylazine\u2010associated wounds. It offers a standardised tool to evaluate wound severity, guide treatment, and improve patient outcomes. As xylazine use rises and further research refines prognostic indicators and treatment outcomes, HEAL\u2010X provides a framework on which to build.<\/jats:p>","DOI":"10.1111\/iwj.70758","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T01:44:58Z","timestamp":1756777498000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<scp>HEAL<\/scp>\u2010X: A Novel Classification System for Xylazine Associated Wounds"],"prefix":"10.1111","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9571-174X","authenticated-orcid":false,"given":"Dante J.","family":"Terracciano","sequence":"first","affiliation":[{"name":"Cooper Medical School of Rowan University  Camden New Jersey USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Savannah F.","family":"Steinhauser","sequence":"additional","affiliation":[{"name":"Cooper Medical School of Rowan University  Camden New Jersey USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camille E.","family":"Introcaso","sequence":"additional","affiliation":[{"name":"Cooper Medical School of Rowan University  Camden New Jersey USA"},{"name":"Department of Medicine, Division of Dermatology Cooper University Hospital  Camden New Jersey USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alyssa","family":"Sinko","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Cooper University Hospital  Camden New Jersey USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"D'Orazio","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Cooper University Hospital  Camden New Jersey USA"},{"name":"Cooper Center for Healing Cooper University Hospital  Camden New Jersey USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raquel","family":"Nahra","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Cooper University Hospital  Camden New Jersey USA"},{"name":"Department of Critical Care Medicine Cooper University Hospital  Camden New Jersey USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John M.","family":"Porter","sequence":"additional","affiliation":[{"name":"Department of Surgery Cooper University Hospital  Camden New Jersey USA"},{"name":"Center for Trauma Services Cooper University Hospital  Camden New Jersey USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8277-4928","authenticated-orcid":false,"given":"Matthew S.","family":"Salzman","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Cooper University Hospital  Camden New Jersey USA"},{"name":"Cooper Center for Healing Cooper University Hospital  Camden New Jersey USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,9]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2022.306881"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2022.109380"},{"key":"e_1_2_12_4_1","unstructured":"R.Erin E.Sisco A.Thomson et\u00a0al. \u201cRapid Analysis of Drugs: A Tool to Detect Drug Overdose Spikes Build Trust Among People Using Drugs and Reduce Overdoses\u2013Maryland November 2021\u2013August 2022 \u201d2023."},{"volume-title":"Xylazine (Tranq) Exposure Among People Who Use Substances in Philadelphia","year":"2022","author":"Bettigole C.","key":"e_1_2_12_5_1"},{"key":"e_1_2_12_6_1","unstructured":"The White House The United States Government \u201cBiden\u2010Harris Administration Designates Fentanyl Combined With Xylazine as an Emerging Threat to the United States \u201d2023."},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.forsciint.2014.03.015"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-011-9662-6"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/15563650.2022.2063135"},{"key":"e_1_2_12_10_1","article-title":"A Case of Skin Necrosis Caused by Intravenous Xylazine Abuse","author":"McNinch J. 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