Managing Martorell Ulcer - CVD And Diabetes - THE DAILY CRUCIBLE

Breaking

Ads

Friday, January 11, 2019

Managing Martorell Ulcer - CVD And Diabetes

 


A Martorell ulcer occurs in patients with long-standing hypertension, usually women over 60 years old. Arterial hypertension is present in 95% to 100% of cases, and diabetes has been reported in up to 60% of patients. Notably, in 5% to 10% of patients, diabetes was reported as the unique cause. Martorell was originally described as occurring in females, aged 50 to 70 years, with a history of hypertension. However, newer studies cannot confirm a female preponderance.

A Martorell ulcer is a painful ulceration of the lower leg associated with diastolic arterial hypertension. It was first identified by the Spanish cardiologist Fernando Martorell in 1945, who characterized this ulcer as ‘hypertensive ischaemic ulcers’ or ‘hypertensive leg ulcers’.

A Martorell ulcer occurs in patients with long-standing hypertension, usually women over 60 years old. Arterial hypertension is present in 95% to 100% of cases, and diabetes has been reported in up to 60% of patients. Notably, in 5% to 10% of patients, diabetes was reported as the unique cause. Martorell was originally described as occurring in females, aged 50 to 70 years, with a history of hypertension. However, newer studies cannot confirm a female preponderance.

The original description of Martorell ulcers and the subsequently reported cases showed that the clinical pattern and wound history were very similar from one series to another. The lesion initially appears as small, painful blister(s) that may or may not be associated with trauma. A martorell ulcer starts as a rapidly developing painful, purpuric, necrotic, and finally ulcerated lesion on the antero-lateral side of the leg or on the posterior side of the ankle, including on the Achilles tendon, surrounded by a red purpuric margin spreading regularly and centrifugally. The second clinical characteristic of a Martorell ulcer is extreme pain, more severe than would be expected for the size of the ulcer. Healing occurs is between 3 to 11 months. According to the initial definition of a Martorell ulcer, the existence of significant peripheral arterial occlusive disease (PAOD), should be an excluding criterion for this diagnosis. However, venous or arterial insufficiencies occur far more commonly in the elderly. A Martorell ulcer result from a micro-angiopathic process.

Prevention relies on the correct management of hypertension and avoiding non-selective β-blockers, which will lower skin perfusion pressure. Treatment of the ulcer involves awareness and early correct diagnosis, adequate control of both blood pressure and diabetes, management of infection, and wound care - d-net@idf.org

No comments:

Post a Comment