The Tropical Diabetic Hand Syndrome

Abstract

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.

Tropical diabetic hand syndrome- a case report with a short review

“…2,4 TDHS is an aggressive type of hand sepsis that results in significant morbidity and mortality among patients of diabetes in the tropics. 10 TDHS has also been reported among diabetic patients in the Indian subcontinent. 7,8 The present case also belongs to a beautiful and naturally gifted part of the subcontinent, the Kashmir valley.…”

Characterizing Hand Infections in an Underserved Population: The Role of Diabetic Status in Antibiotic Choice and Infection Location

“…Consistent with data reported by other centers, S. aureus was the most commonly identified pathogen in culture overall. [18][19][20][21][22][23] The etiologic agents of hand infection were comparable between the DM and no-DM groups: rates of identification of all S. aureus, MRSA, gram-negative organisms, and polymicrobial cultures did not differ significantly between DM and no-DM groups. The literature describes the rates of culture of gram-negative organisms from hand infections as ranging from 51.1 to 73% in diabetics and 8 to 11.3% overall.…”

Hand infection in patients with diabetes: a series of 17 cases and a pooled analysis of the literature

“…The majority of reports related to hand infections in diabetes are from developing countries in the tropical world and it is defined as diabetic hand syndrome with musculoskeletal manifestations such as limited joint mobility, Dupuytren's contracture, and trigger fingers (10,11,(13)(14)(15)17,19,21,24,31,37,40,41). Diabetes and related complications are common in Turkey but only three studies about hand complications related to diabetes from this country were found in the literature (2,6,20).…”

“…Late admission to hospital reduced the success of the treatment (10,13,20,21,27,36). The rate of late admission was 96.97% and the mean time for admission was 1.38 weeks in our review of the literature.…”

“…Although musculoskeletal manifestations such as limited joint mobility, Dupuytren's contracture, and trigger fingers are the most commonly published conditions of diabetic hand, hand ulcer with infection can cause even more serious complications such as gangrene, amputation of an extremity, or even death of the patient (8,9). In the literature, there are many independent risk factors for developing diabetic hand syndrome such as peripheral neuropathy, poorly or uncontrolled diabetes, female sex, insect bites, hand trauma, low socioeconomic status, residence in coastal areas, and late administration to hospital (6,10,11).…”