Diabetic Hand Infection: An Emerging Challenge

Abstract

Background: Hand infection in diabetics is an often ignored but challenging condition. If not addressed effectively, it may result in long term disability, contracture, amputation and even death. Methods: From August 2014 to December 2015, a study was done in our centre, where 49 diabetic hand infection cases were analyzed in two groups, superficial and deep hand infection. Results: Mean age of the patients was 51.63 years. There were 21 superficial infections and 28 deep infections. Cause of infection was unknown or spontaneous in 16 cases, traumatic laceration or crush in 14 patients, following minor prick in 10 cases. Most of the cases were the results of neglected minor wound. Forty-one patients were insulin dependent. Five cases were diagnosed as diabetic at the time of treatment. Four patients were treated conservatively and 45 (92%) cases required operation in the form of incision, drainage and debridement. In 16 (35%) cases, wound was left open and was healed by secondary intention following regular dressing. In five patients, wound was closed secondarily. Partial thickness skin graft was applied in 15 cases. Seven patients were treated with flap coverage. Partial digital or ray amputation were done in 16 cases. All fingers except thumb were amputated in one case and amputation from wrist was done in another patient. Wound swabs were taken, and antibiotics were changed or continued accordingly. But reports of 26 cases were available. No growth was found in four cases, monomicrobial infection was found in 15 patients and polymicrobial in seven cases. Infection resolved with healing in 47 cases. Two patients died during treatment from sepsis, both were insulin dependent, had associated renal failure and from deep infection group. One patient developed severe mental disorder. Conclusions: For diabetic hand infection, early diagnosis and prompt treatment with appropriate antibiotics and emergency surgery with extensile incision is crucial. Primary amputation of the part could be life and limb saving.

Diabetic Hand Infections: Factors at Presentation Influencing Amputation and Number of Surgical Procedures

“…We chose to study these six variables, since they have been the subject of examination in some earlier studies. 8 9 10 11 Quantitative variables are summarized using mean and standard deviation (SD). Qualitative variables are summarized using frequency and proportion.…”

Upper limb infections: A comparison between diabetic and non-diabetic patients

“…4,5 Because of poor recovery, minor superficial infections may spread into deeper structures in upper limbs, causing massive tissue destructions or even sepsis. 6,7…”

“…8 Diabetic patients tend to have more extensive infection, 9 longer time for recovery 10 and end up with amputation 11,12 or death following sepsis. 7 Furthermore, the long-term morbidities that resulted from infection are more significant in diabetic patients. Inadequate or late treatment can result in severe stiffness, contracture and ultimately loss of hand function.…”

“…4,5 Because of poor recovery, minor superficial infections may spread into deeper structures in upper limbs, causing massive tissue destructions or even sepsis. 6,7 Although diabetic hand infections are less common than foot ulcers, the outcomes are often disappointing. 8 Diabetic patients tend to have more extensive infection, 9 longer time for recovery 10 and end up with amputation 11,12 or death following sepsis.…”

Vacuum-Assisted Therapy for Combined Volar-Dorsal Soft-Tissue Defects of the Hand: A Case Report

“…Complex infections of the hand can be an intractable consequence of uncontrolled diabetes. [7][8][9] Attaining control of a severe infection in the setting of vasculopathy, hyperglycemia, and poor nutrition can be challenging. Hand amputation may be lifesaving but is obviously not an acceptable primary treatment option for most patients, especially for the dominant hand.…”