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“Diabetic Hand”: Clinical and Biochemical Profiles
Sreekanth Raveendran, MS, Ortho, PDFHS; Binu.P Thomas, MS, Ortho, PDFHS
Dr. Paul Brand Centre for Hand Surgery, Christian Medical College Vellore, Vellore, India

Introduction: “Diabetic Hand” denotes infections of the hand when diabetes associated complications accentuate the severity of infection and complicate its treatment. There is a paucity of literature regarding the clinical and biochemical profile of patients with diabetic hand.
Materials and Methods: A retrospective analysis of patients admitted with diabetic hand infection at our tertiary care specialist hand unit between June 2004 to May 2010 were done, to identify and correlate the clinical presentation, biochemical and microbiological parameters, treatment and final outcome. The resulting data was analyzed using SPSS™.
Observations: Thirty nine patients (M:F 1.6:1) with Type 2 Diabetes Mellitus (DM), mean age 50.89 years with an average 6.42 years of diabetic treatment prior to presentation were identified. Only 11 patients had a prior history of trauma. 11 were newly detected diabetic. Others had a mean prior diabetic treatment of 6.42 years. Seven patients had underwent surgery elsewhere before presenting to us. 54 % of patients presented as necrotizing fascitis (NF); 26% as abscess(AB), and 20 % as suppurative tenosynovitis(STS). The mean delay in seeking expert treatment was 6.1 days. The mean value of HbA1c was 10.07% and was statistically significant with type of infection; blood glucose value at presentation with the duration of treatment and delay in seeking treatment with the type of infection. The mean stay of patients in hospital was 17.72 days. The mean fasting glucose values at presentation and discharge were 17.42 mmol/land 6.29 mmol/l respectively. Gram negative bacterial infection was predominant with gram positve bacteriae seen only in nine patients. In patints with MRSA (n=5), the mean HBA1c was 13.52%. 31% (n=12) patients had only debridement as surgical procedure. 38% (n=15) patients needed skin and soft tissue cover procedures. 7 %( n=3) had flap (cross finger =2 & Reverse Posterior Interosseous Artery flap= 1) cover. 31% had Split skin grafting. 18% (n=7) required amputations. Three patients required bony stabilization and skin cover. Total 53.85% (n=21) patient required skin cover procedures.
Conclusions and clinical relevance: Diabetes mellitus turn the simple infection into grievous type, makes its treatment complicated and accentuates its morbidity. There is a narrow window of opportunity to diagnose and save diabetic hands. Control of Blood sugar is the best way to prevent diabetic hand infection. Early detection of infection saves limb and its function. All hand infections in diabetic patients must be aggressively treated.

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