Arteriolosclerotic ulcer of Martorell

Abstract

In 1945, Martorell described ischaemic leg ulcers in patients with hypertension. He suggested that the ischaemic necrosis was secondary to a hypertensive arteriolar disease and referred to them as 'hypertensive ischaemic ulcers'. In recent years, the specific entity of these ulcers has been questioned. Others claim they have a much higher incidence, but presume the diagnosis is frequently missed. Almost 900 cases of Martorell's ulcers have been reported in literature since the first description. A systematic review and comprehensive search of literature (evidence-based) was needed to characterize this type of ulcer. Based on aetiology and histopathology, it seems to be justified to maintain the name 'arteriolosclerotic ulcer of Martorell'. We conclude that the arteriolosclerotic ulcer of Martorell is a specific entity with its own clinical and histological diagnostic keys, wound management and preventive measures. We introduce a set of criteria that may be used to facilitate diagnosing arteriolosclerotic ulcer of Martorell as well as a flowchart that includes diagnosis, treatment and prevention of this particular type of vascular leg ulcer.

Calciphylaxis and Martorell Hypertensive Ischemic Leg Ulcer: Same Pattern - One Pathophysiology

“…It was Schnier et al [13] , who described the typical location on the laterodorsal leg, and several authors, among them Bertranou et al [14] , Lazareth and Priollet [15] and Dagregorio and Guillet [16] , recommended early debridement and skin grafting to enhance wound healing and effectively alleviate pain. In their comprehensive review from 2010, Vuerstaek et al [8] collected 889 cases published in 53 articles and theses. Some authors argue that Martorell HYTILU may in fact be more common than previously acknowledged and that many physicians may be totally unaware of the entity.…”

“…Martorell HYTILU is characterized by a progressive, extremely painful skin necrosis of the lower leg [7,8] , with a marked predisposition for the laterodorsal lower leg or above the Achilles tendon ( fig. 2 c).…”

Chapter 6 - Oral medication

“…If an ulcer has an atypical appearance or responds inadequately to the therapy, then the possibility of another diagnosis such as a malignancy vasculitis, other dermatological diseases or arteriolosclerosis (Martorell ulcer) 51 should be considered and a skin biopsy should be obtained. 39,52 In one trial, chronic leg ulcers referred to tertiary care centre contained 10.4% malignancies.…”

Autologous Adipose Tissue Graft to Treat Hypertensive Leg Ulcer: A Pilot Study

“…These ulcers are extremely painful, superficial, rapidly spreading with a fibrinous and necrotic wound bed surrounded by red purpuric margins. They are mainly localized on the dorsolateral part of the leg [3] . Histology is not specific but necessary to exclude other diagnoses.…”