PDF herunterladen
CC BY-NC-ND 4.0 · Indian J Plast Surg 2021; 54(03): 289-296
DOI: 10.1055/s-0041-1735421
Original Article

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

Sanjai Ramkumar
1   Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
,
Madhu Periasamy
1   Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
,
Praveen Bhardwaj
1   Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
,
R Ravindra Bharathi
1   Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
,
Monusha Mohan
1   Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
,
S Raja Sabapathy
1   Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
› Institutsangaben
Funding The authors have no sources of financial or material funding to disclosure. No portion of this work has been previously presented or published. All authors were involved in the clinical care of the patients, design and conception of this paper, and the writing and revising process. Our study was performed in accordance with and conforming to the Declaration of Helsinki.
› Weitere Informationen
Auch verfügbar auf
  Lizenzen und Reprints

Abstract

Background Diabetic hand infections are associated with significant morbidity and disability. Amputations cause permanent disability, and multiple surgical procedures lead to morbidity. Diabetic foot infections have been well-studied but literature on hand infections is limited. We undertook a retrospective study of patients with diabetic hand infections operated at our center to study the factors at presentation with significant association with amputation and number of surgical procedures.

Patients and Methods Demographic data of 51 patients was collected. The six parameters, namely, duration of diabetes, “onset of symptoms to presentation” interval, presence of comorbidities, HbA1c level, random blood sugar (RBS) levels at admission, and culture characteristics were selected for statistical analysis to find a relationship with the two outcome variables: number of procedures done and need for amputation.

Results On bivariate analysis, Gram-negative infection was found to have a significant relationship with the need for multiple of procedures (p = 0.014). The mean difference between the “onset of symptoms to presentation” interval between the amputation/non-amputation groups (2.9 days, p = 0.04) and the multiple procedures/non-multiple procedure groups (4.4 days, p = 0.02) was found to be statistically significant. Presence of comorbidities, long duration of diabetes, HbA1c, and RBS levels at admission did not show any statistically significant association with the two outcome variables studied.

Conclusion In the present study, we found that infection with Gram-negative organisms is significantly related to the need for multiple surgical procedures. A delay in presentation can influence the risk of amputation as well as multiple procedures. Institution of early appropriate care is important to get a good outcome.

Keywords

diabetes - hand infection - amputation - gram-negative infection - wound infection


Publikationsverlauf

Artikel online veröffentlicht:
02. Oktober 2021

© 2021. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Mann RJ, Peacock JM. Hand infections in patients with diabetes mellitus. J Trauma 1977; 17 (05) 376-380
    CrossrefPubMedSuche in Google Scholar
  • 2 Benotmane A, Faraoun K, Mohammedi F, Benkhelifa T, Amani ME. Infections of the upper extremity in hospitalized diabetic patients: a prospective study. Diabetes Metab 2004; 30 (01) 91-97
    CrossrefPubMedSuche in Google Scholar
  • 3 Stern PJ, Staneck JL, McDonough JJ, Neale HW, Tyler G. Established hand infections: a controlled, prospective study. J Hand Surg Am 1983; 8 (5 Pt 1) 553-559
    CrossrefPubMedSuche in Google Scholar
  • 4 Maloon S, de Beer JV, Opitz M. Acute flexor tendon sheath infections. J Hand Surg Am 1990; 15: 474-477
    CrossrefSuche in Google Scholar
  • 5 Raveendran S, Naik D, Raj SC Pallapati, Prakash JJ, Thomas BP, Thomas N. The clinical and microbiological profile of the diabetic hand: a retrospective study from South India. Indian J Endocrinol Metab 2016; 20 (05) 619-624
    CrossrefPubMedSuche in Google Scholar
  • 6 Chatterjee N, Chattopadhyay C, Sengupta N, Das C, Sarma N, Pal SK. An observational study of cutaneous manifestations in diabetes mellitus in a tertiary care Hospital of Eastern India. Indian J Endocrinol Metab 2014; 18 (02) 217-220
    CrossrefPubMedSuche in Google Scholar
  • 7 Tiwari S, Chauhan A, Sethi NT. Tropical diabetic hand syndrome. Int J Diabetes Dev Ctries 2008; 28 (04) 130-131
    CrossrefPubMedSuche in Google Scholar
  • 8 Nthumba P, Cavadas PC, Landin L. The tropical diabetic hand syndrome: a surgical perspective. Ann Plast Surg 2013; 70 (01) 42-46
    CrossrefPubMedSuche in Google Scholar
  • 9 Abbas ZG, Lutale J, Gill GV, Archibald LK. Tropical diabetic hand syndrome: risk factors in an adult diabetes population. Int J Infect Dis 2001; 5 (01) 19-23
    CrossrefPubMedSuche in Google Scholar
  • 10 Bahar Moni AS, Hoque M, Mollah RA, Ivy RS, Mujib I. Diabetic hand infection: an emerging challenge. J Hand Surg Asian Pac Vol 2019; 24 (03) 317-322
    CrossrefPubMedSuche in Google Scholar
  • 11 Gonzalez MH, Bochar S, Novotny J, Brown A, Weinzweig N, Prieto J. Upper extremity infections in patients with diabetes mellitus. J Hand Surg Am 1999; 24 (04) 682-686
    CrossrefPubMedSuche in Google Scholar
  • 12 Abbas ZG, Archibald LK. Tropical diabetic hand syndrome. Epidemiology, pathogenesis, and management. Am J Clin Dermatol 2005; 6 (01) 21-28
    CrossrefPubMedSuche in Google Scholar
  • 13 Wang C, Lv L, Wen X. et al A clinical analysis of diabetic patients with hand ulcer in a diabetic foot centre. Diabet Med 2010; 27 (07) 848-851
    CrossrefPubMedSuche in Google Scholar
  • 14 Gill GV, Famuyiwa OO, Rolfe M, Archibald LK. Serious hand sepsis and diabetes mellitus: specific tropical syndrome with western counterparts. Diabet Med 1998; 15 (10) 858-862
    CrossrefPubMedSuche in Google Scholar
  • 15 Francel TJ, Marshall KA, Savage RC. Hand infections in the diabetic and the diabetic renal transplant recipient. Ann Plast Surg 1990; 24 (04) 304-309
    CrossrefPubMedSuche in Google Scholar
  • 16 Gürbüz K, Ekinci Y. Is the preoperative glycated hemoglobin (HbA1c) level predictive of the severity of diabetic hand infection according to surgical and clinical outcomes?. Exp Clin Endocrinol Diabetes 2019; (e-pub ahead of print). doi:
    Thieme ConnectPubMedSuche in Google Scholar
  • 17 Pinzur MS, Bednar M, Weaver F, Williams A. Hand infections in the diabetic patient. J Hand Surg [Br] 1997; 22 (01) 133-134
    CrossrefPubMedSuche in Google Scholar
  • 18 Padmavathy K, Krishnan RS, Padma K, Sathyapriya B. Nasal colonization of methicillin resistant Staphylococcus aureus and its plausible association with infected foot ulcers in diabetic patients. Indian J Public Health Res Dev 2019; 10: 182-183
    CrossrefSuche in Google Scholar
  • 19 Mofikoya BO, Ajani A, Ugburo AO, Olusoga O. Surgical outcomes of diabetic hand infections in Lagos, Nigeria. Malawi Med J 2019; 31 (03) 198-201
    CrossrefPubMedSuche in Google Scholar