Ulcus hypertonicum Martorell

Das Ulcus hypertonicum Martorell ist ein äußerst schmerzhafter ischämischer Hautinfarkt, meistens auf distaler bis mittlerer Höhe an der lateralen-dorsalen Seite des Unterschenkels lokalisiert. Seine Ursache liegt in einer stenosierenden subkutanen Arteriolosklerose. Die Diagnose wird vermutlich häufig verpasst, da das Krankheitsbild in der medizinischen Lehre weitgehend fehlt. Die Verwechslung mit einem Pyoderma gangraenosum kann therapeutische Fehlentscheidungen nach sich ziehen.

Abstract

Martorell hypertensive ischemic leg ulcer (HYTILU) is a skin infarction of the lower leg caused by subcutaneous arteriosclerosis. Most often, the rapidly progressive ulceration occurs on the laterodorsal lower leg or over the Achilles tendon. The necrotizing process at the wound edge is extremely painful and often rapidly progressive. The wound margin is sometimes black and sometimes livid and undermined, which can make it difficult to distinguish from pyoderma gangraenosum. In histology pathologic arterioles with a thickened vessel wall and a narrow lumen are seen at the dermal-subcutaneous junction. In 75 % of histological sections, miniaturized medial calcinosis can be found. Subendothelial hyalinosis with reduced cell density of the vessel wall is a very specific histological feature of hypertensive arteriolosclerosis. 100 % of affected individuals have arterial hypertension and 60 % have type 2 diabetes mellitus. The treatment of Martorell HYTILU is empiric. There are virtually no comparative randomized controlled clinical trials. Small-surface, superficial wounds resulting from Martorell HYTILU are best debrided with restraint, and the refreshed wound surface is covered with punch grafts from the thigh. Large and deep wounds are excised down to the fascia, the wound surface is brought to granulation with Negative Pressure Wound Treatment, and then covered with a split-thickness skin graft. Skin grafts can be used already at the beginning of wound management. For critically ill patients with a maximally extensive and progressive Martorell HYTILU, daily infusion of sodium thiosulfate can improve the healing potential and pain. According to current understanding, sodium thiosulfate has a beneficial hemorreological effect, and decalcifies the arteriolar wall. It is particularly important that the diagnosis of Martorell HYTILU is not confused with pyoderma gangraenosum at the start of therapy because the therapies are completely different.

Schlüsselwörter

Ulcus hypertonicum Martorell - Hautinfarkt - Arteriolosklerose - Mediakalzinose - Calciphylaxis - medial calcinosis

Keywords

Martorell hypertensive ischemic leg ulcer - skin infarction - arteriolosclerosis - calciphylaxis

Publikationsverlauf

Artikel online veröffentlicht:
14. August 2023

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