Diabetic Hand Infection: An Emerging Challenge
Ahmed Suparno Bahar Moni1, Monirul Hoque2, Rayhan Ali Mollah2
1Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Penang and WIDAD University College, Kuantan, Malaysia.
Insights
Diabetic hand infections are serious and require prompt surgical intervention. Early diagnosis and treatment, including potential amputation, can prevent severe complications like sepsis and limb loss.
Area of Science:
- Medicine
- Surgery
- Infectious Diseases
Background:
- Diabetic hand infections are a significant clinical challenge with potential for severe outcomes including disability, contracture, amputation, and death.
- Neglected minor wounds are a common precursor to these infections in diabetic patients.
Purpose of the Study:
- To analyze the characteristics and treatment outcomes of diabetic hand infections.
- To evaluate the effectiveness of surgical interventions and conservative management.
Main Methods:
- A retrospective analysis of 49 diabetic hand infection cases from August 2014 to December 2015.
- Cases were categorized into superficial and deep infections, with analysis of infection causes, patient demographics, and treatment modalities including surgery (incision, drainage, debridement, amputation) and wound closure techniques.
Main Results:
- The majority of patients (41/49) were insulin-dependent. Most infections stemmed from neglected wounds.
- Surgical intervention was required in 92% of cases. Treatments included debridement, skin grafting, flap coverage, and amputation in 16 cases.
- Infection resolved in 47 cases, but two patients died from sepsis, and one developed a severe mental disorder.
Conclusions:
- Early diagnosis and prompt, aggressive treatment, including emergency surgery with extensile incisions and appropriate antibiotics, are critical for managing diabetic hand infections.
- Primary amputation may be life- and limb-saving in severe cases.
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.
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