Hand and Foot Sepsis in Libyan Diabetic Patients

Bosseri, Soad; Gill, Geoffrey

doi:10.1177/004947559702700417

Cited by 17 publications

(19 citation statements)

References 5 publications

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“…The most useful African studies available are those from Nigeria 8 and Libya. 13 The frequency of hand sepsis was remarkably similar in the two -5/158 patients (3.2 %) in Nigeria and 25/814 in Libya (3.1 %), as was the female excess (80 % in Nigeria and 74 % in Libya). Mean ages were 41 years and 51 years, respectively.…”

Section: Aetiology and Risk Factorsmentioning

confidence: 87%

“…Of Akintewe and colleagues original 5 cases, 8 4 had finger amputations (80 %), and the fifth patient took their own discharge. In the series of 60 cases reported by Bosseri and Gill, 13 there was an 11 % amputation rate, again mostly of digits. This was, however, a retrospective 'status of survivors' study.…”

Section: Outcome and Managementmentioning

confidence: 88%

“…As well as the obvious endpoint of amputation, many who escape this treatment are left with functional disability, and prolonged hospitalization is often needed (in one report a mean of 31 (range 6-75) days). 13 There is no detailed available information on mortality, though it is striking that all of the 4 Tanzanian patients reported by Archibald et al 14 died, and one of the 2 reported by Gill et al 6 probably died after discharge. Even survivors who escape major amputation frequently have serious loss of function, which may be catastrophic for the wage-earner of the family.…”

Section: Outcome and Managementmentioning

confidence: 98%

“…13 Of 815 patients, 60 (7.4 %) had suffered 90 episodes of foot or hand infection. The hand was involved in 31 (34 %) cases.…”

Section: Clinical Features Of Diabetic Hand Sepsis In the Tropicsmentioning

confidence: 99%

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Serious hand sepsis and diabetes mellitus: specific tropical syndrome with western counterparts

Gill

Famuyiwa

Rolfe³

et al. 1998

Diabet. Med.

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Infection in the extremities of diabetic patients most commonly involves the feet and, at least in western societies, is often associated with chronic complications of diabetes. Severe hand infection, often culminating in amputation and even death, is, however, well-described in tropical countries, where it may not be associated with any evidence of neuropathy or arterial insufficiency. Similar cases are described in the western literature but are more often associated with more severe antecedent trauma. The literature describing hand sepsis in diabetic patients both in tropical and in western practice is reviewed and we draw some conclusions about pathogenesis and treatment from the literature and from original data documenting the varying experience of hand sepsis in diabetic practice throughout Africa.

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Section: Aetiology and Risk Factorsmentioning

confidence: 87%

Section: Outcome and Managementmentioning

confidence: 88%

Section: Outcome and Managementmentioning

confidence: 98%

“…13 Of 815 patients, 60 (7.4 %) had suffered 90 episodes of foot or hand infection. The hand was involved in 31 (34 %) cases.…”

Section: Clinical Features Of Diabetic Hand Sepsis In the Tropicsmentioning

confidence: 99%

See 2 more Smart Citations

Serious hand sepsis and diabetes mellitus: specific tropical syndrome with western counterparts

Gill

Famuyiwa

Rolfe³

et al. 1998

Diabet. Med.

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“…1,2,13,17,21,22 Reports from North Africa suggest that TDSH patients from that region may have more favorable outcomes than those from sub-Saharan Africa. 13,21,22 TDHS may follow minor trauma to the hand that the patient may ignore or forget; in some patients however, there is no identifiable cause. 16 Trauma was identifiable in only 2 patients (20%) in the current study.…”

Section: Discussionmentioning

confidence: 99%

The Tropical Diabetic Hand Syndrome

Nthumba¹,

Cavadas²,

Landín³

2013

Annals of Plastic Surgery

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Tropical diabetic hand syndrome (TDHS) is an aggressive type of hand sepsis that results in significant morbidity and mortality among patients with diabetes in the tropics. This study set out to establish a protocol for the holistic management of TDHS to improve digit/hand salvage and function at AIC Kijabe Hospital. This prospective study examined the following demographics of patients presenting to the authors institution between October 2009 and September 2010 with TDHS: their sex, age, comorbidities, length of in-hospital stay, surgical and medical treatment, total cost of treatment, and immediate postdischarge outcomes. A total of 10 patients (3 men and 7 women) were presented with TDHS during the study period. Surgical procedures included a thorough debridement of the hand at initial presentation, followed by procedures aimed at preserving length and hand function, with digit or hand amputation when there was no possibility of salvage. Three hands were salvaged, without the need for an amputation; 2 of these, however, developed severe stiffness with resultant poor function. Fifty percent of the patients developed considerable disability; 3 of these patients had disabilities of the arm, shoulder, and hand, (DASH) scores of >90 at 6 months after treatment. TDHS appears to be more aggressive in some patients than in others; a multidisciplinary approach, with early involvement of the surgical team, and a radical surgical debridement are essential to improved outcomes. Although the goal of medical treatment (ie, glycemic control) is simple and easily achieved, surgical goals (salvage of limb or life, preservation of hand function) are more complex, costly, and difficult to achieve. Educating health care workers, diabetic patients, and their relatives on hand care is an important preventive measure. Diligence in taking antidiabetic medicine, early presentation, and appropriate care of TDHS are required for meaningful improvement in outcomes of patients with diabetes who develop hand sepsis in the tropics.

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