SCIENCE, PRACTICE AND EDUCATION Figure 1: Typical clinical presentation of HYTILU on the Achilles tendon. Figure 2: Typical clinical presentation of HYTILU on the lateral aspect of the leg. more than 60 years old. Even though these ulcers HYTILU were assessed with pulse palpation to rule have traditionally been associated with uncontrolled out peripheral artery disease and, in cases of absence high blood pressure, they also commonly present fol- or doubt, a toe-brachial index was performed. All lowing many years of well-controlled arterial hyper- patients presented with typical clinical features, and tension and type 2 diabetes mellitus. Some patients biopsies were only taken to rule out other differential describe a minor trauma as the trigger, but others diagnoses. Demographic data from patients, their report only a spontaneous onset with an initial livid comorbidities and wound characteristics were reg- macule. 3 By definition, Martorell patients have no istered. Data were obtained from the database of a end-stage renal disease; otherwise, they would qualify previous study approved by the ethics committee. for the distal form of ‘classical’ calciphylaxis. Calci- For statistical analysis, all qualitative variables are de- phylaxis is a condition characterised by necrosis of the scribed by percentage, while quantitative variables are skin and subcutaneous tissue, which shares clinical described by the mean and range. and histological features with Martorell ulcers, but this is seen mainly in patients with end-stage kidney RESULTS disease. Forty-one patients were included in this case series study, of which 32 (78%) were women and 9 (22%) Considering the typical histopathology of the under- were men. The mean age was 73 years (range: 45–94 lying arterioles, which show arteriosclerotic changes years old). In all, 34 patients (83%) presented with with a distinctive wall thickening that results in a nar- high blood pressure, 19 (46%) with type 2 diabetes row lumen, the term hypertensive ischemic leg ulcer mellitus and 20 (49%) with dyslipidaemia. Three (HYTILU) has been coined. 4 However, the epony- patients were active smokers, and one patient was a mous term ‘Martorell ulcer’ continues to be used. former smoker. It is also remarkable that nine (22%) presented with ischemic myocardiopathy. It should As there are still aspects to be defined about the aeti- be noted that only two (5%) had poor control of their opathogenesis of Martorell ulcer and the risk factors high blood pressure. Three patients presented with that may be involved, we have conducted a descrip- chronic venous insufficiency (7.3%), and three had tive retrospective study on demographic character- non-severe stages of chronic kidney disease (Table 1). istics and comorbidities in a series of patients with Only 2.44% of the wounds were biopsied to confirm Martorell ulcers. diagnosis, and pyoderma gangrenosum (PG) was the differential diagnosis to rule out in those cases. MATERIALS AND METHODS Regarding treatment for comorbidities, eight (19.5%) Patients with Martorell HYTILUs treated in the out- of the patients were taking beta-blockers, and 13 patient wound practice of a public university hospital (31.7%) were treated with vitamin K antagonists at in Madrid between October 2015 and January 2020 the time of the initial consultation. The average time were included in this single-centre descriptive retro- until referral to our specialised clinic was 3 months spective study. All patients diagnosed with Martorell (range: 2 weeks-–15 months). As for the surface of JOURNAL OF WOUND MANAGEMENT 29 OFFICIAL JOURNAL OF THE EUROPEAN WOUND MANAGEMENT ASSOCIATION
Download PDF file
Build your own flipbook