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CC BY-NC-ND 4.0 · Indian J Plast Surg 2021; 54(03): 289-296
DOI: 10.1055/s-0041-1735421
Original Article

Diabetic Hand Infections: Factors at Presentation Influencing Amputation and Number of Surgical Procedures

Sanjai Ramkumar
1   Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
,
Madhu Periasamy
1   Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
,
Praveen Bhardwaj
1   Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
,
R Ravindra Bharathi
1   Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
,
Monusha Mohan
1   Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
,
S Raja Sabapathy
1   Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
› Author Affiliations Funding The authors have no sources of financial or material funding to disclosure. No portion of this work has been previously presented or published. All authors were involved in the clinical care of the patients, design and conception of this paper, and the writing and revising process. Our study was performed in accordance with and conforming to the Declaration of Helsinki.
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Abstract

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.

Keywords

diabetes - hand infection - amputation - gram-negative infection - wound infection


Publication History

Article published online:
02 October 2021

© 2021. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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