Soft tissue infections are a serious health concern among people who use drugs, especially those who inject, as they can lead to severe complications if left untreated. For years, harm reduction clinics have played a vital role in treating these infections, as highlighted in the 2002 study of the Casa Segura Wound and Abscess Clinic. However, the emergence of necrotic wounds linked to drug contaminants, such as xylazine, presents a new challenge requiring updated care models. This article explores the evolution of wound care in harm reduction clinics, with a focus on the Oakland County Health Division’s program. Building on the 2002 Casa Segura study, it highlights key changes in treatment, such as addressing new drug contaminants like xylazine, and integrating nurse practitioners and point-of-care drug testing to improve patient outcomes. The Oakland County program not only responds to these emerging challenges but also stresses the importance of specialized wound care and better healthcare access for people who inject drugs. By offering practical solutions, it shows how harm reduction programs have evolved to meet contemporary needs, improving care for individuals with injection-related wounds.