Clinical characteristics and misdiagnosis analysis of hand skin and soft tissue defects
WANG Li
YANG Shanhui
SUN Fuzhai
QU Long
HUO Yongxin
WU Xueqiang
SUN Rutao
Abstract：Objective To investigate the clinical characteristics,causes of misdiagnosis,and preventive measures for hand skin and soft tissue defects.Methods A retrospective analysis was conducted on the case data of 7 patients with hand skin and soft tissue defects who were misdiagnosed as having other diseases from January 2022 to June 2024.Results Three patients presented with local skin damage accompanied by mild pain,with irregular wound edges and pale bases.They were initially diagnosed as having superficial skin abrasions.After conventional debridement and bandaging treatment,the wounds continued to exude fluid and failed to heal.Subsequently,bacterial culture of the wounds identified Staphylococcus aureus in two patients and Pseudomonas aeruginosa in one patient.Histopathological examination showed necrosis of the dermis with inflammatory cell infiltration.Finally,they were diagnosed as infectious skin and soft tissue defects.Two patients presented with progressive swelling of the hand,increased skin temperature,and tenderness.Due to the obvious swelling,no clear skin break was palpable.They were initially diagnosed as cellulitis,but empirical use of broad-spectrum antibiotics for one week was ineffective.Magnetic resonance imaging examination showed subcutaneous fat layer defect with involvement of the fascia layer.Combined with the history of trauma,they were diagnosed as traumatic skin and soft tissue defects.The other two patients presented with chronic ulcers at the metacarpophalangeal joint,and the wound edges were undermined with serous exudate.Based on medical history,they were initially diagnosed as diabetic dermopathy and were treated with wound dressing changes and blood sugar control for 2 weeks,but the wound area expanded.Color Doppler ultrasound of the blood vessels showed stenosis of the radial artery branch,and the transcutaneous oxygen partial pressure was<30 mmHg.Finally,they were diagnosed as ischemic skin and soft tissue defects.The duration of misdiagnosis was 2 to 6 weeks.After diagnosis,infected patients underwent thorough debridement+sensitive antibiotic treatment;trauma patients underwent local flap transfer repair;ischemic patients received vascular interventional angioplasty combined with negative pressure drainage.After 3 months of follow-up,6 cases of wounds healed completely,and 1 ischemic patient needed secondary blood supply reconstruction due to poor vascular conditions.Conclusion The clinical manifestations of hand skin and soft tissue defects are not typical,and they are prone to misdiagnosis as common diseases such as superficial abrasions and cellulitis.In clinical practice,it is essential to enhance awareness of differential diagnosis.Combined imaging,microbiological and pathological examinations should be conducted when necessary to improve the diagnostic accuracy.
Keywords：hand skin and soft tissue defectmisdiagnosissuperficial skin abrasioncellulitisdiabetic dermopathydifferential diagnosis
Publication Date：2026-03-13
Online Publishing Date：2026-03-20(First online date of this platform, not the publication date of the document)
Pages：6( 6-11 )