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.
An open fracture with extensive skin and soft tissue loss is considered as a severely injured lower extremity. Advances in rapid transport, resuscitation, skeletal fixation, and microsurgical techniques to cover large soft tissue and bone defects have made possible the salvage of these severely injured limbs. Salvage exercise is skill and resource intensive and could take a long time frame. The goal of management is to obtain painless independent weight bearing walking in a time frame and cost that the patient can afford.Decisions taken and the quality of care provided on day 1 determine the ultimate success. Inappropriate decisions and treatment lead to increased morbidity and secondary amputation. Infection is the commonest complication. Limb salvage scores are helpful to predict salvage and guide the sequence of treatment. Once the decision is taken for salvage, debridement, early skeletal fixation, and soft tissue cover are the key to success.
An entrapped finger is a relatively uncommon domestic injury. When the finger gets stuck proximal to the proximal interphalangeal joint, the resultant distal edema and inappropriate attempts at retrieval can result in circumferential degloving of the skin and injury to the neurovascular structures. We report a technique that can be used in such circumstances. Strategically placed skin sutures are used to get the skin through the constricting ring, and retrieval is aided by a cut finger glove that wraps the finger and can be lubricated. This non-cutting technique is named as the parachute technique since the withdrawn skin sutures look like the strings of the parachute. This technique is valuable when the finger gets stuck in an idli plate, a common South Indian kitchen utensil, where there is difficulty of access to cutting equipment and where inappropriate attempts at retrieval can result in skin injury making further attempts more difficult.
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