The Ischemic/Septic Diabetic Hand: Review of Literature and a Case Report

Crisci Alessandro

doi:10.11648/j.js.20180604.11

Abstract

The term “diabetic hand” was born to describe the complications of the diabetes mellitus on the hand resulting in a rigid hand with a poor mobility. The traumatic wounds with soft tissue involvement increase the risk of infection. Staphylococcus aureus methicillin-resistant (MRSA) is the most common bacterium isolated in the hand infections. The case report of a type 2 diabetic patient, dialysed with chronic obstructive peripheral artery disease and Monckeberg sclerosis of the vessels of the hands, ischemic necrosis of the right hand fingers is reported by the authors. In the diabetic patient the hands can be infected in the same way that feet could be infected too. Several amputation interventions have been performed with the intent of saving part of the hand. The diabetic hand syndrome (DHS) is an important pathology that requires strong antibiotics and surgery to avoid severe disability as rigidity, contracture and amputation. Apparently, in the last years good results are reported using antibiotic, surgical and hyperbaric treatment. In conclusion it would be wrong to ignore or underestimate this disease and any doctor should practice a scrupulous visit of the hands in the diabetic patient.

Highlights

The diabetic hand syndrome (DHS) is definited as a clinical condition based on a vascular, neuropathic and infective pathogenesis caused by a cronic hyperglicemy with or without a pre-existing ischemy triggered by traumatic lesions of the upper limbs
The term “diabetic hand” was born to describe the complications of the diabetes mellitus on the hand resulting in a rigid hand with a poor mobility
Staphylococcus aureus methicillin-resistant (MRSA) is the most common bacterium isolated in the hand infections

Summary

Introduction

The diabetic hand syndrome (DHS) is definited as a clinical condition based on a vascular, neuropathic and infective pathogenesis caused by a cronic hyperglicemy with or without a pre-existing ischemy triggered by traumatic lesions of the upper limbs. The immunodeficiency causes a higher risk of severe hand infections, sometimes life-threatening. The most common bacterium is the staphylococcus (Table 1) and other microorganisms can be involved both as single bacterium infection and as polimicrobic infection including Gram- bacteria (Enterobacter, Streptococcus, Pseudomonas aeruginosa, anaerobic bacteria and fungal infection) [4, 5]. Staphylococcus aureus methicillin-resistant (MRSA) is the most common bacterium isolated in the hand infections. The fungal infection can result in a trivial onychomycosis and in a life-threatening disease if the infection is severe with deep layers involvement. Staphylococcus aureus was the most common bacterium isolated in the hand infections (34%). The natural evolution of the DHS is the fulminant sepsis due to the infection and to the progressive hand necrosis (Meleney’s gangrene)

Review of the Literature

Case Study

Findings

Discussion

Conclusion