Tropical diabetic hand syndrome: Surgical management and proposed classification

Abstract

Introduction: Hand complications of diabetes mellitus are rare compared to those in the foot. They occur in the ratio of 1:20 in our observations. We managed 36 patients with tropical diabetic hand syndrome and propose a classification for the disease that will allow communication between physicians and prognostication. Materials and Methods: Patients with hand infections and background diabetes mellitus were admitted. Their age, sex and occupations were noted. A clinical diagnosis was made and drained. Wound swab for culture was taken. Wounds were generally serially debrided at bed side with wound being allowed to granulate over time to be subsequently closed by split thickness skin graft. Results: Thirty six patients were studied. Based on their clinical diagnosis, they were classified into three (I,II,III) groups in increasing order of severity. The classification correlated with the type and severity of the disease. It also guided the choice of appropriate treatment. Conclusion: Based on our findings, tropical diabetic hand syndrome was classified and prognosticated based on the degree of soft tissue and bone involvement. The classification allows for communication with other physicians.