Comparison of pyoderma gangrenosum and Martorell hypertensive ischaemic leg ulcer in a Swiss cohort

Kolios, Antonios; Hafner, Jürg; Luder, C.; Guenova, Emmanuella; Kerl, Katrin; Kempf, Werner; Nilsson, Jakob; French, Lars E.; Cozzio, Antonio

doi:10.1111/bjd.15901

Cited by 20 publications

(22 citation statements)

References 8 publications

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“…Skin biopsy does not appear necessary for the positive diagnosis of HLU but supports the diagnosis of HLU in cases of doubt and is required for a differential diagnosis, such as pyoderma gangrenosum [14] in the case of an atypical wound.…”

Section: Resultsmentioning

confidence: 99%

Cutaneous Arteriolosclerosis Is Not Specific to Ischemic Hypertensive Leg Ulcers

et al. 2018

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Section: Resultsmentioning

confidence: 99%

Cutaneous Arteriolosclerosis Is Not Specific to Ischemic Hypertensive Leg Ulcers

et al. 2018

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“…The ulcers mentioned above whose shared histopathology was subcutaneous ischemic arteriolosclerosis can be wrongly diagnosed as pyoderma gangrenosum because of clinical similarity and inadequate biopsies. 3 , 4 , 12 Moreover, superficial biopsy samples taken from many types of chronic wound base can be misdiagnosed as pyoderma gangrenosum because necrotic dermis with sheets of neutrophil granulocytes can be found. In a study by Hafner et al .…”

Section: Discussionmentioning

confidence: 99%

A case of chronic ulcer due to subcutaneous arteriolosclerosis in an obese patient mimicking pyoderma gangrenosum

Fıçıcıoğlu¹,

Can

Tutuğ

2018

Dermatol Reports

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The differential diagnosis of chronic ulcers covers a wide range of diseases and poses a diagnostic challenge. Subcutaneous ischemic arteriolosclerosis can lead to local ischaemia and ulceration as a result of arteriolar narrowing and reduction of tissue perfusion. This pathophysiological feature can be seen in eutrophication (nonuremic calciphylaxis) in morbid obesity, hypertensive ischemic leg ulcer (Martorell ulcer) and calciphylaxis in chronic renal insufficiency. All of the ulcers happened in this way can be wrongly diagnosed as pyoderma gangrenosum because of clinical similarity and inadequate biopsies. We report a case of chronic ulcer due to subcutaneous arteriolosclerosis in morbid obesity, wrongly diagnosed as pyoderma gangrenosum. It can be detrimental to misdiagnose the ulcers due to subcutaneous arteriolosclerosis as pyoderma gangrenosum since they need a diametrically different approach.

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“…Исследования показали, что наличие гиперплазии интимы является основным фактором образования язвы. Напряжение сдвига, вызванное постоянно высоким уровнем артериального давления, стимулирует ремоделирование эндотелия с утолщением стенки сосуда, сужением его просвета и, как следствие, нарушением кровоснабжения участка кожи пораженной конечности [24,25]. Также было признано, что имеет место потеря компенсирующего физиологического рефлекса вазодилатации дистальных артериол в области закупорки, что еще больше ухудшает перфузию тканей.…”

Section: обзор литературыunclassified

Martorell’s ulcer: a literature review and own clinical observation

Болдин

Голосницкий

Богачёв

et al. 2021

Ambulatornaya khirurgiya

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Introduction. Martorell’s ulcer is a rather rare pathology that occurs exclusively in patients with long-term and poorly controlled arterial hypertension and continues to be one of the poorly studied areas of modern surgery. There are few reports on the occurrence of this pathology in the medical literature and, as a rule, describe extremely rare clinical cases. The issues of etiology, pathogenesis and differential diagnosis of this disease continue to cause debate. The article provides a review of the literature on this rare surgical pathology, presents its own clinical observation, discusses the issues of diagnosis and treatment options for this disease.Clinical case. A 56-year-old patient was admitted with complaints of a non-healing trophic ulcer on the lateral surface in the lower third of the right leg since one year ago with severe pain syndrome not adequately controlled with non-narcotic analgesics. he received treatment in an outpatient department and in the hospital, underwent courses of rheological therapy to the ulcer region as a local therapy, used a wide range of dressings of domestic and foreign origin. No positive effect was reported on the top of already administered combination therapy, the ulcer continued to increase in size. A Martorell’s ulcer was diagnosed, and a decision was made to provide a course of presurgical conservative rheological therapy with PGE1 (VAP 20 mg), antibiotic therapy, and local therapy aimed at maximal ulcer necrotic tissue clearance before the forthcoming planned surgical treatment. The patient underwent the surgery – autodermatoplasty of the trophic ulcer of the right leg with a mesh graft, continued local treatment of the ulcer using dressings with peruvian balsam and other medications on an outpatient basis without chemical and biological components from the antiseptics and healing stimulants group. Two months after the surgery, the patient had no complaints, the pain syndrome in the ulcer region completely regressed, no edema occurred in the lower operated leg, the right let ulcer completely healed with the formation of a permanent scar.Conclusion. Surgical management is the final and definitive treatment for Martorell’s chronic hypertensive ulcer and should be carried out promptly to minimize the spread of the ulcer and minimize a pain syndrome.

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Comparison of pyoderma gangrenosum and Martorell hypertensive ischaemic leg ulcer in a Swiss cohort

Cited by 20 publications

References 8 publications

Cutaneous Arteriolosclerosis Is Not Specific to Ischemic Hypertensive Leg Ulcers

Cutaneous Arteriolosclerosis Is Not Specific to Ischemic Hypertensive Leg Ulcers

A case of chronic ulcer due to subcutaneous arteriolosclerosis in an obese patient mimicking pyoderma gangrenosum

Martorell’s ulcer: a literature review and own clinical observation

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