Synonym(s)
hypertensive-ischemic ulcers; hypertensive ulcers; hypertonic ulcer; Infarct ulcer; ischemic leg ulcer; Leg ulcer ischemic; Martorell's syndrome; Martorell ulcer; Matorell hypertensive ischemic leg ulcer; Ulcer Martorell; Whip-like pain syndrome
HistoryThis section has been translated automatically.
Martorell, 1945; Hines and Farber, 1946
DefinitionThis section has been translated automatically.
Usually sudden, unilateral or bilateral (50% of patients are affected bilaterally), rapidly progressive, circumscribed, ischemic, 2.0-5.0 cm large, highly painful leg ulcer, usually localized in the distal, latero-dorsal parts of the lower leg. Often a banal everyday trauma is given as the initial trigger. The main symptom is the sudden, almost unbearable, ischaemic infarction pain.
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EtiopathogenesisThis section has been translated automatically.
The aetiological assessment of Martorell's ulcers has been revised by several publications to the effect that, in addition to hypertension, subcutaneous arteriolosclerosis (in targeted deep biopsies a high percentage of calcifying arteriosclerosis can be detected in serial sections) is of decisive importance. Frequently (in about 60% of patients) diabetes mellitus can also be detected.
ManifestationThis section has been translated automatically.
Women are preferentially affected (m:w = 4:6); in larger studein the mean age was 72 years.
LocalizationThis section has been translated automatically.
Outside of the lower legs, symmetrically over the ankles or Achilles heel.
Clinical featuresThis section has been translated automatically.
Sudden, circumscribed, highly painful, polycyclic, sharply margined ulcer with bluish-livid or black-fringed edges, which developed from a black-necrotic precursor. Most patients have a marked, usually treatment-requiring, long-term hypertension, often combined with type 2 diabetes (>50% of patients). Subtle arteriosclerosis screening can detect peripheral AVK in > 50% of patients.
LaboratoryThis section has been translated automatically.
Unobtrusive
HistologyThis section has been translated automatically.
In sufficiently deep excisional biopsy from the edge of the ulcer and with subtle serial histology, stenotic arteriosclerotic, sometimes calcified changes in the subcutaneous arterioles can be detected in 3/4 of the patients.
General therapyThis section has been translated automatically.
The vast majority of patients have underlying peripheral arterial occlusive disease. Therefore, in order to check the indication for vascular intervention or vascular reconstruction, the ankle arm index should be determined by Doppler sonography and blood pressure measurement and, if necessary, arterial digital subtraction angiography should be performed.
External therapyThis section has been translated automatically.
Internal therapyThis section has been translated automatically.
Treatment of high blood pressure, pain therapy.
Operative therapieThis section has been translated automatically.
Surgical debridement usually leads to a rapid improvement of the very severe pain. Sufficiently deep excision, skin necroses are excised down to the fascia of the lower leg, followed by vacuum therapy for 6-10 days.
Frequent need for antibiotics postoperatively (caution: laboratory inflammation values are not conclusive: CRP is usually already elevated due to the existing ulcer; if necessary, decide according to clinical criteria).
+ if necessary split skin transplantations
Not infrequently, several follow-up surgical interventions are necessary until the wounds have healed completely.
LiteratureThis section has been translated automatically.
- Hafner J et al (2010) Martorell hypertensive ischemic leg ulcer. Arch Dermatol 146: 961-968
- Hines E, Farber E (1946) Ulcer of the leg due to arteriolosclerosis and ischemia occurring in the presence of hypertensive disease (hypertensive-ischemic ulcers): A preliminary report. Mayo Clin 21: 337-346
- Martorell F (1945) Las ulceras supramaleolares por arteriolitis de las grandes hipertensas. Actas Reuniones Cientificas Cuerpo Facultativo Instituto Policlinico Barcelona 1: 6
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Incoming links (12)
Arterial leg ulcer; Calciphylaxis; Hypertonic ulcer; Hypertonic ulcer; Infarct ulcer; Leg ulcer, ischemic; Livedoid vasculopathy; Livedo racemosa; Livedovasculopathy; Martorell fernando; ... Show allOutgoing links (1)
Venous leg ulcer;Disclaimer
Please ask your physician for a reliable diagnosis. This website is only meant as a reference.
Prof. Dr. med. Peter Altmeyer