engleski

Martorell Ulcer

Martorell ulcer (hypertensive ischemic ulcer) is an exceptionally painful ulceration on the lower leg, associated with poorly controlled, long- lasting arterial hypertension, and sometimes with diabetes as well. It appears at an older age, more often in women, and on the lateral aspect of the lower leg (above the lateral malleolus) or in the region of the Achilles tendon. It can be bilateral. The ulcer does not react to standard ulcer therapy, and can progress by widening of the ischemic area. It is caused by the sclerosis of the arteriole in the dermis accompanied by vasoconstriction, with no lesions on larger blood vessels (arteriosclerosis). Biopsy of the ulcer and the surrounding skin can confirm diagnosis of a hypertensive ulcer ; the tissue specimen should comprise the subcutaneous fatty tissue. Histologically, there is a thickening of the arteriolar wall, as well as sclerosis and hyalinization. The basic therapy includes the treatment of hypertension using beta blockers, calcium channel inhibitors, and ACE inhibitors. Even a minimal decrease in blood pressure may have a significant effect on the healing of the ulcer and decrease in pain. Compressive wound dressing also helps, as well as negative pressure therapy ; skin transplantation is very effective. Martorell ulcer is difficult to diagnose, since it is first necessary to exclude all other possible causes of the ulcer. The disease is not very common, but should be considered in cases of lower leg ulcers that do not react to therapy, and in cases where the diseases of the arteries and veins of the lower leg have not been established.

Martorell Ulcer ; dermatology ; phlebology

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