SCIENCE, PRACTICE AND EDUCATION DOI: 10.35279/jowm202104.04 Comorbidities and clinical features of Martorell hypertensive ischemic leg ulcers: findings from a retrospective cohort study Juan José Téllez Zaya , Hospital Universitario Infanta Leonor, Madrid Elena Conde-Monter o , PhD. Department of Dermatology, Hospital Universitario Infanta Leonor y Virgen de la Torre, Madrid. Lorena Recarte Marín , Centro de Especialidades Vicente Soldevilla, Madrid Laura Pérez Jerónimo , Centro de Especialidades Vicente Soldevilla, Madrid Alicia Peral Vázquez , Centro de Especialidades Vicente Soldevilla, Madrid Alba Casillas Pérez , Centro de Especialidades Vicente Soldevilla. Madrid Pablo de la Cueva Dobao , PhD, Chief of Service. Department of Dermatology, Hospital Universitario Infanta Leonor y Virgen de la Torre, Madrid Correspondence:: elenacondemontero@gmail.com · Conflicts of Interest: None Keywords: Martorell ulcer, hypertensive ischemic leg ulcer, arteriolosclerosis, epidemiology, hypertension ABSTRACT Background Martorell hypertensive ischemic leg ulcers are com- monly misdiagnosed, and their prevalence may be underestimated. There are still some aspects to be defined about the aetiopathogenesis of Martorell ulcers and the risk factors that may be involved with them. Methods This is a single-centre retrospective case series study on the demographic characteristics and comorbidi- ties in a series of patients with Martorell ulcer treated at a public university hospital in Madrid. Results Comparing our results to previous studies, which are few and include small samples, the risk factors that we outline are an average age over 70 years and high blood pressure. Only two (5%) participants had poor control of their high blood pressure. Conclusions and Implications for Clinical Practice Defining the epidemiological features of this type of leg ulcer may be very useful in differential diagnosis with other disorders, such as pyoderma gangreno- sum. venous insufficiency, arterial insufficiency and neu- ropathy. However, other less common aetiologies do exist and should be considered for differential diag- nosis when atypical features arise, or when a wound does not respond to an accurate standard treatment.1 These less frequent wounds are classified as ‘atypical’ wounds. Martorell ulcers are included in this group. In 1945, Fernando Martorell 2 described four cases of supramalleolar ulcers with underlying arteriolitis in obese women with uncontrolled hypertension. From then on, many authors have published various clini- cal and histological features that characterise these lesions. 2,3 The incidence of these ulcers is underestimated be- cause they are an under-diagnosed type. This diag- nostic failure is essentially due to a lack of knowledge of the existence of this entity. Consequently, it is essential to carry out studies that provide keys to facilitating its recognition and diagnosis. The typical clinical presentation is a painful ulcer over the Achilles tendon or dorsolateral leg. Multiple bilateral lesions may be present in half of the cases. Skin infarction typically begins as a livid, painful area that rapidly turns into a necrotic lesion with reddish- purple edges. The development of satellite lesions is common (see Figures 1 and 2). INTRODUCTION The most common causes of lower limb ulcers are Regarding epidemiological features, Martorell ulcers are more frequent in women, and most patients are 28 JOURNAL OF WOUND MANAGEMENT OFFICIAL JOURNAL OF THE EUROPEAN WOUND MANAGEMENT ASSOCIATION
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