Dr Bengusu Oroglu Istanbul Faculty of Medicine Underwater and Hyperbaric Medicine Department

1. A case of diabetic hand wound
Dr Bengusu Oroglu
Istanbul Faculty of Medicine
Underwater and Hyperbaric Medicine
Department

2. • 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

3. • 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

4. 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.

5. • 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

6. • 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

7. • 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 treatment19th day of treatment

8. • 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

9. 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.

10. • 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