Tropical diabetic hand syndrome: Surgical management and proposed classification

Lawal, Yau Zakari; Ogirima, MO; Dahiru, I L; Girei, Bakari A; Salisu, Muazu B

doi:10.4103/2278-9596.122931

Cited by 9 publications

(16 citation statements)

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“…While many researchers have reported amputation rates ranging from 13.9% in Northern Nigeria to 16% in Sudan and Hong Kong14–16, two-thirds of our present cohort of patients presented with gangrene (digits in 13 patients and the hand in 1 patient), thus necessitating digit or forearm amputations. This could be explained by late presentation as over half of our patients presented with overt gangrene.…”

Section: Discussionmentioning

confidence: 63%

Surgical outcomes of diabetic hand infections in Lagos, Nigeria

Mofikoya

2019

Mal. Med. J

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Background Hand infections in diabetics can be a major cause of functional impairment .In patients with Tropical Diabetic hand syndrome prompt surgical intervention may salvage the hand, but return to premorbid function remain a challenge.Objectives A retrospective study of consecutive diabetic patients with hand infections was done in 2 tertiary institutions in Lagos,Nigeria to identify the epidemiology, modes of presentation, types of surgical intervention and outcomes oftreatment.Results Twenty one patients were studied over a 5 year period. ten males, eleven females .All were type 2 Diabetes. 52.4%(11) were diagnosed less than a year prior to presentation. 61.9%(13) had digit/hand gangrene on presentation. All operated patients (20) had wound debridements. 52.5% (11) digit/hand amputations and this was the commonest surgical procedures done. Other surgeries done include skin grafts and `flap reconstructions. There was a 19% mortality rate. Less than a fifth were able return to their premorbid occupation after 3 months. But all had reduced range of motion in the interphalangeal joints in the adjacent digits.ConclusionsThere is a high morbidity rate for hand infections in the diabetic, even though majority of the hands were salvaged, most patients were unable to return to their premorbid occupation at 3 months.

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Section: Discussionmentioning

confidence: 63%

Surgical outcomes of diabetic hand infections in Lagos, Nigeria

Mofikoya

2019

Mal. Med. J

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“…Diabetic hand infections in diabetic patients are as serious as diabetic foot ulcers but so far only a few studies related to diabetic hand ulcers have been published in the literature, because hand infections in diabetic patients are observed less frequently than foot infections, plus hand complications of diabetes mellitus are rare compared to foot complications, occurring at a rate of 1/20 (37)(38)(39).…”

Section: Discussionmentioning

confidence: 99%

“…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).…”

Section: Discussionmentioning

confidence: 99%

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

2018

Turk J Med Sci

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The aim of this study was to report the clinical characteristics and the treatment outcomes of hand infections in diabetic patients and to review the literature. Materials and methods:The medical records of 17 patients with diabetic hand infections admitted to the Diabetic Foot Care Center of two different clinics from January 2012 to October 2017 were reviewed. To perform the pooled analysis, published series (32 studies) were searched in two international databases (www.scopus.com and www.pubmed.com).Results: Of the 17 patients (mean age 61.7 ± 8.5 years), 8 (47.1%) were female. All cases were type 2 diabetes mellitus. The mean duration of diabetes was 9.0 ± 5.96 years and the mean HbA1c was 7.86 ± 1.88%. There was necrosis in 8 patients (47.1%). The most common causes were injury during saw and hammer use in 5 patients (29.4%) and injury due to inappropriate nail cutting in 3 patients (17.6 %). Nine (52.9%) patients were operated on. No patients underwent any major amputations or died. In 32 publications, 704 patients with diabetic hand infections were found. The average age was 53.43 years (n = 591) and 84.29% of patients (322/382) were found to have type 2 DM. The mean duration of diabetes was 4.12 years (n = 317) and the mean HbA1c was 10.58% (n = 140). The rate of surgical operation was 74.59% (323/433). Conclusion:Diabetic hand injuries often occur when using hand tools such as hammers, saws, and knives, and when cutting nails. It is necessary to use conservative treatment rather than amputation. These patients should consult experienced health care professionals.

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“…Unlike diabetic foot infections, no classification has been adopted for TDHS despite the rising need for a classification that will enable early decision making, proper management and good communication amongst physicians [ 1 ]. Lawal et al in 2013 described a new course of management based on a proposed new classification of TDHS [ 1 ]. They classified TDHS into three groups (I–III) based on the increasing order of severity of the disease and prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…Hand complications of diabetes mellitus are rare compared to foot complications occurring in a ratio of 1:20 [ 1 ]. Tropical diabetic hand syndrome (TDHS) describes an acute complex hand complication affecting patients with diabetes in the tropics usually following a minor injury to the hand [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Tropical diabetic hand syndrome: a case report

et al. 2017

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BackgroundTropical diabetic hand syndrome describes a complex hand sepsis affecting patients with diabetes across the tropics and often results from a trivial hand trauma. The clinical presentation of this syndrome is variable and ranges from localised swelling and cellulitis, with or without ulceration of the hand to progressive fulminant hand sepsis, and gangrene affecting the entire limb which may be fatal. Tropical diabetic hand syndrome could lead to permanent disability and death as a result of delay in presentation, late diagnosis and late medical and surgical intervention. This indexed case acts as an eye opener for physicians to the existence of this hand sepsis.Case presentationWe report the case of a 57 year-old black African female diabetic who was referred to our centre for the management of a suppurating ulcer and swelling of the left hand of two weeks duration. On examination and work-up, the patient was found to have Lawal Group III left diabetic hand syndrome and was managed with parenteral antibiotics, radical debridement and the hand was eventually amputated. She died 7 days following amputation from overwhelming sepsis.ConclusionThough tropical diabetic hand syndrome is a relatively rare complication of diabetes, it can be fatal as in this case report. Early diagnosis and proper management would yield better outcome. Initial management should include aggressive intravenous broad-spectrum antibiotics with anaerobic coverage. Classification of tropical diabetic hand syndrome will assist physicians and surgeons in decision making, proper management and easy communication.

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Tropical diabetic hand syndrome: Surgical management and proposed classification

Cited by 9 publications

References 0 publications

Surgical outcomes of diabetic hand infections in Lagos, Nigeria

Surgical outcomes of diabetic hand infections in Lagos, Nigeria

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

Tropical diabetic hand syndrome: a case report

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