Upper extremity infections in patients with diabetes mellitus

Forty-five consecutive diabetic patients with 46 upper extremity infections who underwent surgical debridement were retrospectively reviewed. The infe ctions involved the skin or subcutaneous tissue in 19 patients and the fasc ia, tendon, muscle, or bone in 27. Twenty-three infections (50%) required a single operation and 23 required more than 1. Eighteen infections (39%) re quired an amputation and there were 3 deaths directly related to an infecti on. Six of 7 infections in which anaerobic organisms were cultured culminat ed in amputation. Four patients were diagnosed with necrotizing fasciitis. Twenty-one cultures (46%) were polymicrobial. An increased rate of amputati on was associated with deep infections below the subcutaneous tissue, renal failure, and infections with gram-negative, anaerobic, or polymicrobial cu ltures. An increased rate of repeat surgery and a prolonged hospitalization were associated with deep infection and polymicrobial infections. (I Hand Surg 1999;24A:682-686. Copyright (C) 1999 by the American Society for Surge ry of the Hand.).