From the Guidelines
Dry gangrene of the toe is characterized by a darkened, mummified appearance with the affected tissue turning black, brown, or dark purple, and a clear line of demarcation between healthy and dead tissue, as described in the 2016 IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes 1. The toe becomes cold, dry, shriveled, and hard with a leathery and wrinkled skin appearance, and the toe may eventually become completely black and mummified. Some key features of dry gangrene include:
- A darkened, mummified appearance
- Affected tissue turning black, brown, or dark purple
- Clear line of demarcation between healthy and dead tissue
- Cold, dry, shriveled, and hard toe
- Leathery and wrinkled skin appearance
- Loss of sensation in the affected area due to nerve damage Dry gangrene develops gradually due to arterial insufficiency, where blood supply to the toe is severely reduced or completely blocked, causing tissue death. Common causes include:
- Peripheral arterial disease
- Diabetes
- Severe frostbite
- Raynaud's phenomenon Treatment typically involves addressing the underlying cause, managing risk factors, and possibly surgical removal of the dead tissue (debridement) or amputation if necessary, as recommended in the 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections 1. Immediate medical attention is essential as dry gangrene can progress and lead to serious complications if left untreated. In some cases, autoamputation of the necrotic tissue may occur, especially in ischemic feet, and it is often best to avoid debriding the necrotic tissue in these cases, as suggested in the 2016 IWGDF guidance 1.
From the Research
Toe Appearance with Dry Gangrene
- Dry gangrene is characterized by a lack of blood supply to the affected area, resulting in tissue death and necrosis 2.
- The appearance of toes with dry gangrene can include:
- Shrinkage and contraction of the skin
- Darkening of the skin to a black or blue-black color
- Mummification of the tissue
- Eventual sloughing off of the dead tissue
- Dry gangrene can occur in patients with underlying conditions such as diabetes mellitus, peripheral vascular disease, or renal disease 2.
- The treatment of dry gangrene typically involves surgical debridement, antibiotic therapy, and management of the underlying condition 3, 4, 2.
- Hyperbaric oxygen therapy may also be used as an adjunctive treatment to enhance tissue oxygenation and promote healing 3, 4.