Diabetic Hand Problems

Abstract

A retrospective review of hand infection cases for the period of 2006-2010 aws performed. We studied 37 patients with diabetic hand infection. The average age was 62 (23-87). 54% were male and 46% were female. 10 patients required insulin injection of which 27 was initially on oral medication. Out of these 27, 5 needed to switch to insulin injection during hospital stay. 15 patients (40%) had polymicrobial infection. Out of 15 patients; 11 patients (73%) required multiple amputation. 4 patients (27%) required digital amputation. 13 patients (35%) had superficial infection while 24 patients (65%) had deep infection. Out of there 24 patients with deep infection, 19 (79%) required digital amputation. There was no proximal amputation. Deep infection results in significantly prolonged hospital stay (average 16 days). Key points in management include Proper glycerin control to decrease immunopathy Proper immobilization during acute infection to slow down spread of infection and control edema ¬ Early aggressive antibiotic management to cover mixed growth Aggressive exploration and radical repeated debridement to control infection Digital amputation should be considered early if the digit is not able to achieve reasonable function Start hand rehabilitation early and keep non-infected part mobile