Trophic or hypertensive ulcer of Martorell
In the middle of the last century, the Spanish doctor Fernando Martorell Otzet described a trophic ulcer of the lower extremities, which he called “Martorell’s hypertensive ulcer”. He believed that its occurrence was associated with arterial hypertension. In addition, according to the doctor, the pathophysiology of hypertensive ulcers is based on impaired blood circulation in the skin.
When a patient is diagnosed with a trophic ulcer, or Martorell ulcer, this is an accurate definition of the type of disease.
Martorell’s ulcer
The location and spread of Martorell ulcers (hypertonic ulcers) has its own characteristics – most often they form on the front, outer or back of the surface of the lower legs and feet. This disease mainly affects women over 40 years of age. At the initial stage of development, shallow ulcers are observed, without visible granulation, minor wounds, in places there are areas of black dermis necrosis. If you do not pay attention to these signs in time and do not consult a doctor, the size of the ulcers will increase, a secondary infection will join them.
Martorell’s ulcer at the beginning of treatment
Martorell syndrome at the end of treatment – ulcer healing
However, the most characteristic feature of hypertensive ulcers among other types of lower limb ulcers is the intense pain syndrome: This pain causes severe suffering for the patient. Even a minor dressing turns into a painful procedure for the patient. There are cases when the pain syndrome cannot be removed or weakened even by strong analgesics. During my practice of treating Martorell ulcers, I have met patients who had suicidal thoughts, which arose as a result of prolonged and continuous pain. Because of this pain, patients are deprived of normal sleep, they develop significant psycho-neurological disorders.
During this disease, pathophysiological changes in the vessels are also observed, which can be detected during duplex examination; this examination can also show whether there is damage to the main arteries and veins. The diagnosis of Martorell’s ulcer is also confirmed by microscopy of a biopsy of the skin and subcutaneous tissue, which reveals hyalinosis of the walls and endothelial proliferation with complete disappearance of the vascular lumen.
Martorella’s trophic ulcer in its “pure” form, as described by the Spanish doctor Fernando Martorella, is not very common. Patients, in addition to arterial hypertension, may also have concomitant pathology – varicose veins, obliterating atherosclerosis, diabetes mellitus, overweight, etc. If concomitant pathology is added to Martorella’s ulcer, the diagnosis and treatment of arterial ulcers becomes even more difficult.
The treatment process of Martorell’s trophic ulcer
Treatment of hypertensive ulcers is an extremely difficult task. Even the slightest touch to the surface of the ulcer during bandaging can cause the patient not only discomfort, but also unbearable suffering. All medications and ointments that are applied to the surface of the ulcer only cause a sharp increase in pain. Depending on the stage of the disease, the drugs used to treat the ulcer are selected. Sometimes it is necessary to change several dozen ointments, creams, and powders to achieve a positive result. During the treatment of Martorell ulcers, or Martorell syndrome ICD 10, it is necessary to correct blood pressure.
Woman, 53 years old. Disabled person of group II. Martorell ulcer. Blood pressure – 3,000 mm Hg. Pronounced pain syndrome
Complete healing of the ulcer. Reduction of blood pressure to 1,800 mm Hg.
Left lower limb. Martorell’s trophic ulcer. Before treatment
Right lower limb. Trophic ulcer of Martorell. beginning of treatment
Trophic ulcer of Martorell in the process of treatment
The result of the treatment of Martorell’s trophic ulcer
Martorell’s trophic ulcer complicated by stroke. Start of treatment
The result of the treatment of Martorell’s tortic ulcer
Trophic ulcer of Martorell
The result of the treatment of Martorell’s trophic ulcer