Patterns of finger sepsis and predictors of its outcome in patients with diabetic septic hand

Abstract

The objectives of this study were to determine the different patterns of finger sepsis among diabetic patients, to know its different outcomes, and to detect the predictors of poor functional outcome (using the Sollerman hand function test). One hundred diabetic patients with finger sepsis were assessed using a prospective analytical hospital-based study, conducted in Khartoum Teaching Hospital and Jabir Abu Eliz Diabetic Centre (JADC) from October 2015 to October 2016. The most common pattern of finger sepsis was a superficial abscess (27.9%) followed by necrosis (27.1%), gangrene (14%), ulcers (11.5%), and cellulitis (6.3%). Finger sepsis spread to involve the hand in 39 patients (39%). Eighteen patients (18%) had an amputation of one or more fingers, and four patients (4%) had an amputation of the whole hand. Complete healing was the outcome in 82 (82%) patients. Twelve patients (12%) required reconstructive surgery and grafting. Forty-two patients (42%) presented with late complications such as stiffness, contractures, and deformities. Thirty-three patients (33%) had a Sollerman functional score below 80%. Poor control of diabetes, presence of neuropathy, low educational level, delayed presentation to hospital, and severe necrosis requiring surgical reconstruction were significant predictors of poor functional results of the hand (p value 0.05). The loss of more than one finger or the loss of the thumb resulted markedly in reduced hand function, compared to the loss of the middle or ring finger. Stiffness was an influencing factor in reducing hand function. It developed from severe tissue damage and prolonged periods of immobilization in a dressing which covered the whole hand. Finger sepsis among diabetics has different patterns and different outcomes. Better control of diabetes, early presentation to diabetic centers, and proper management of hand wounds will be in favor of good functional outcomes.