Hypertensive ischemic ulcer

Schnier, Brian R.; Sheps, Sheldon G.; Juergens, John L.

doi:10.1016/0002-9149(66)90247-5

Cited by 41 publications

(50 citation statements)

References 3 publications

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“…Their classic location is seen in Figure 4, adapted from the paper of Schnier and Sheps. 5 These lesions are most commonly on the lateral aspects of the lower extremities and often symmetrical. These ulcers usually have been present for long periods of time and found to be refractory to the usual local measures for ulcer healing.…”

Section: Discussionmentioning

confidence: 99%

“…First used by both Martorell 1 and Hines and Farber, 2 other authors employed lumbar sympathectomy to try and vasodilate the affected limb and improve perfusion to the ischaemic ulcer. 5,6,13,15,17,18 All of these are anecdotal reports, and the responses to lumbar sympathectomy varied from clinical observations of distinct ulcer improvement to no evidence of benefit. Lumbar sympathectomy had little impact on systemic hypertension, so it is not surprising that sympathectomy had an uncertain impact on the ischaemia present in hypertensive leg ulcers.…”

Section: Discussionmentioning

confidence: 99%

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Martorell’s hypertensive leg ulcer: case report and concise review of the literature

2001

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Hypertensive leg ulcers (Martorell's ulcers) are a unique form of lower extremity ischaemic leg ulcer. First described by Martorell, and Hines and Farber in the 1940s, these ulcers are defined by pain disproportionate to the size of the ulcer, specific location on the lower extremity, female-to-male predominance, association with long-standing, often poorly, controlled hypertension, and healing response to specific antihypertensive

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Martorell’s hypertensive leg ulcer: case report and concise review of the literature

2001

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“…In 1946-1947, Farber and Hines stressed the link between the striking histopathology of the underlying arterioles showing distinctive wall thickening resulting in a narrow lumen and coined the term still in use today of 'hypertensive ischemic leg ulcer' [11,12] . 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.…”

Section: History Of Calciphylaxismentioning

confidence: 99%

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

Hafner¹

2016

Dermatology

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This review presents a closer look at four diseases which are probably closely related to one another pathophysiologically: (a) calciphylaxis (distal pattern); (b) calciphylaxis (proximal pattern); (c) Martorell hypertensive ischemic leg ulcer; (d) calciphylaxis with normal renal and parathyroid function (synonym: eutrophication). The four diseases have largely the same risk factors: (1) arterial hypertension, (2) diabetes mellitus (types 1 and 2), (3) secondary or tertiary hyperparathyroidism (in end-stage kidney disease) and (4) oral anticoagulation with vitamin K antagonists. They share the same clinical patterns: necrotizing livedo, skin infarctions at typical locations and acral gangrene in calciphylaxis. They also share the same histopathology: ischemic subcutaneous arteriolosclerosis and small-artery disease and ‘miniaturizing' Mönckeberg medial calcinosis. The treatment concept for the acute phase of the diseases is also broadly similar. In addition to an optimized control of the cardiovascular risk factors, a proactive wound approach (necrosectomy, negative pressure wound treatment with vacuum dressings, and early skin grafts supported by systemic antibiotic therapy) leads most rapidly and effectively to a reduction of the initially severe wound pain, and finally to complete healing of the wound. Oral anticoagulation with vitamin K antagonists should be stopped. In extensive cases, the use of intravenous sodium thiosulfate is recommended. All four diagnoses are little known in the medical schools of most countries. The need to improve familiarity with these four closely related disorders is therefore great. In particular, the risk of confusion with pyoderma gangrenosum is a major diagnostic problem which can lead to false and even damaging treatment.

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“…And anaerobial germs and some gram-negative, therefore being well indicated in infectious of the extremities that are associated to vascular alterations, which is why no bacteriological examinations were carried out. 2 One hundred and forty-seven cases of the world literature were reviewed (Table 1), [3][4][5][6][7][8][9][10][11][12][13][14] 112 (76,2%) of the happening in women, 25 (17%) in men, and 10 (6,8%) of non-specified cases. Average age was 63 years, with extremes of 43 and 86.…”

Section: Discussionmentioning

confidence: 99%

“…Various authors have questioned these criteria, especially as to absence of related diseases and most frequent location, as the posterior lateral region has been verified to be the more prevalent. 6,11,13 There are no reports on the necessity of more elaborate exams, such as Doppler or lower limb arteriography, for the diagnosis is basically clinical.…”

Section: Discussionmentioning

confidence: 99%