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Abstract
Purpose
We sought to determine the factors associated with the severity of aggravated hand lesion in patients with diabetes mellitus (DM).
Methods
DM patients with hand lesions ranging from non-suppurative/suppurative to gangrenous (which require surgical treatment) were selected for analysis. Between January 2008 and June 2016, 216 patients with signs of of redness, swelling, and pain with lesions between the fingertip and wrist were analyzed retrospectively. Patients were grouped according to whether they received conservative treatment (group 1) or operative treatment (group 2), and univariate and multivariate analyses were performed according to demographic, laboratory data, co-morbidities, and method of diabetic treatment in both groups.
Results
Age, duration of the morbidity, gender, smoking, co-morbidities, body mass index, other laboratory findings, onset time before treatment, and the presence/classification of trauma history, were all not significant. However, Hb1Ac was found to be 5.96%±0.80% and 8.01%±0.82% in group 1 and 2 respectively, which differed significantly (OR=58.5, p<0.001).
Conclusion
It is possible to manage hand lesions in DM patients with a variety of methods, ranging from conservative to surgical treatment. HbA1c level was determined to be the most important contributing factor in selection of the more rigorous surgical treatment. Moreover, it was determined that even subtle lesions should not be neglected in DM patients as they are susceptible to rapid progression if left untreated.
Figures and Tables
Fig. 1
(A) A 56-year-old woman (group 2) presented with spontaneous discharge on the palm of the left hand without any definitive injury or observed trauma. She was diagnosed with type II diabetes mellitus 4 years ago, and the HbA1C was 9.2% at presentation. (B) Incision and drainage (I and D) under the brachial plexus block in a gangrenous hand was performed and the wound was left open. Two days after or mean±standard deviation., the tissue defect became well demarcated. (C) During hospitalization, I and D was carried out twice a day and intravenous antibiotic were administered. (D, E) After 23 days of wound management, the amount of discharge decreased significantly. (F) Patient follow-up two years after I and D showed that the hand was free from any infectious symptoms and signs. Scarring was visible on the palms and the dorsum. At this point in time, HbA1c levels had returned to within normal ranges.
Fig. 2
(A) A 32-year-old male (group 2) complained of painful swelling on the right 4th finger. He was diagnosed as type I diabetes mellitus (DM) 17 years ago. However, the condition was not managed properly. At presentation, HbA1c was 8.6%. (B) The wound was opened one day after Incision and drainage. (C) After daily irrigation with intravenous antibiotics during a 16-day period of hospitalization, the condition of the finger was determined to be satisfactory and the symptoms of DM were found to be under control.
Fig. 3
A 66-year-old male (group 2) complained of painful swelling on the dorsum of the right hand. He was diagnosed as type II diabetes mellitus 12 years ago. The condition was not managed properly. HbA1c was 7.7% at time of presentation. Skin from the antecubital region was obtained for a skin graft procedure.
ACKNOWLEDGEMENTS
This research was supported by Chungnam National University Hospital Research Fund, 2017.
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