A case of diabetic hand wound

Dr Bengusu Oroglu Istanbul Faculty of Medicine

Underwater and Hyperbaric Medicine Department

• Hand complications are rare in diabetes.

• In fact, diabetic hand refers to musculoskeletal

manifestons, but not the ulcers for many

authors.

• Hand ulcers are generally reported from African

countries and are known as ‘tropical hand

syndrome’.

• Therefore, we wanted share our expriences of a

diabetic hand ulcer.

Introduction

• A 75 year old male applied with a right hand wound.

• He was diabetic for about 30 years and was on insulin therapy for the last fifteen years.

• 20 days before the

application he was wounded by his own partial denture.

Case

Case

• 5 days after the injury , the patient applied to a

local hospital with erythema and edema and pain

of the hand.

• He was admitted to hospital and antibiotherapy

was started.

• At the end of two weeks the wound did not

improve, so hand amputaion was offered.

• When he applied to our center, fever and pain

were present besides the wound.

• Wounds were necrotic and infected with pus.

• Hand was sellulutic.

• Blood sugar levels were not regulated.

• Infection markers were high in spite of normal leukocyte count.

Case

At the time of application

At the time of application

• Insulin therapy regulated

• Wound debrided

• Culture material sent

• Hyperbaric oxygen therapy started.

• Streptococcus species were isolated in culture.

Case

10th day of treatment

5th day of treatment

• Consulted with infectious diseases and proper antibiotherapy started.

• The wounds were followed by regular debridements

and dressing changes.

• Hydrofiber dressings with ionic Ag were preffered for

wound care.

Case

26th day of treatment 19th day of treatment

• At the end of 30 sessions,

HBO therapy was

stopped.

• The patient was followed

for two more weeks.

• The wounds healed totally

at the eight week.

• The patient was referred

to physiotherapy for full

function of the hand.

Case

Discussion

• The diabetic hand wound is a rare complication and is not reported much.

• Early debridement and regular wound care together with proper medication and blood sugar level regulation is the key to treatment.

• Hyperbaric oxygen therapy which is not even mentioned can help to promote healing.

• We wanted to share our expriences and point out that HBO can be useful as an adjunctive therapy.

• Jalil A, Barlaan PI, Fung BKK, Ip WJ, hand

infction in diabetic patients, Hand Surgery, 16:

307-312, 2011

• Wang C, Lv L, Wen X, Chen D, Cent S, Huang

H, Li X, Ran X, A clinical analysis of diabetic

patients with hand ulcer in a diabetic foot center,

Diabetic Medicine, 27:848-851, 2010

References