A comparative study of toluene-induced versus diabetes-induced deep tissue necrosis of the finger: a clinical retrospective study

Reports on hand tissue necrosis induced by toluene or diabetes are scarce. This study compared the onset urgency, postoperative recovery, and finger functional outcomes between patients with deep finger necrosis caused by toluene versus those caused by diabetes. This retrospective study included 77 patients who were hospitalized between April 10, 2020, and April 10, 2025, for redness, swelling, and ulceration of a single finger, and whose postoperative histopathology confirmed deep tissue necrosis. Patients were divided into two groups according to the causative factor: toluene group (Group A, n = 39) and diabetes group (Group B, n = 38). Perioperative parameters were compared, including oedema volume on T2-weighted fat-suppressed MRI sequences, surgical procedure, pre-operative symptom duration, post-operative hospital stay, and pre- and post-operative finger function. Compared with Group B, Group A had significantly larger oedema volumes (20,967.692 ± 645.412 vs. 7,892.711 ± 291.477), a higher proportion of patients undergoing primary incision and drainage with delayed closure (79.487% vs. 23.684%), shorter pre-operative symptom duration [3.000 (1.000, 3.000) vs. 14.500 (10.000, 37.000) days], and shorter post-operative hospital stay [8.000 (5.000, 12.000) vs. 10.000 (8.000, 14.250) days]. Long-term finger function outcomes (DASH scores: 0.491 ± 0.626 vs. 0.307 ± 0.595; grip strength: 100.000 ± 0.000% vs. 99.868 ± 0.811%) were similar between groups. Compared with poorly controlled diabetes, toluene-induced deep necrosis of the finger is associated with a larger extent of necrosis, a higher likelihood of requiring delayed closure after drainage, a more acute onset, and shorter postoperative hospitalization after debridement.