Martorell syndrome (martorell ulcer, hypertonic ulcer)
In the middle of the past century, Spanish doctor Fernando Martorell Otzet described trophic ulcer of the lower limbs, which he named “hypertonic ischemic ulcer”. He believed that its emergence is related to arterial hypertension. He also believed that pathophysiology of hypertonic ulcers is based on impaired blood circulation in skin.
Traditionally the patient is diagnosed with trophic ulcer. In general this is correct.
Features of Martorell syndrome
Location of Martorell ulcers (hypertonic ulcers) has its specific features – most often they develop at the anterior, outer and dorsal surfaces of the lower leg and feet. Mainly women of 40+ suffer from it. At the initial stages of development – ulcers are not deep, without visible granulations, wound discharge is scanty; there are several black sites of dermal necrosis. Without adequate treatment ulcers increase in size and secondary infection ensues.
Intense pain syndrome distinguishes hypertonic ulcer of the lower limbs from other ulcers. Pain is disproportionate to the size and appearance of ulcer. Pain makes the patient suffer. Bandaging becomes a tortures procedure for a patient. In a number of cases even potent analgesics are not able to relieve the pain syndrome. Several patients with Martorell ulcer, whom I treated, had suicidal thoughts. Pain deprives patients from normal sleep; they develop significant psycho-neurological disorders.
Pathophysiological changes in vessels revealed by duplex exam are not adequate to pain: major arteries and veins are not affected. Diagnosis of Martorell ulcer is confirmed by microscopy of skin and subcutaneous tissue bioptate which reveals hyalinosis of walls and endothelial proliferation with complete disappearance of vascular lumen.
Martorell ulcer proper as described by the author does not occur very often. Patients may have concurrent problems – varicosity, obliterating atherosclerosis, diabetes mellitus, etc. besides arterial hypertension. These comorbidities further complicate diagnosis and treatment of arterial ulcers..
Treatment of Martorell ulcer
Treatment of hypertonic ulcer is extremely difficult task. The slightest touch to the ulcer’s surface during bandaging brings intolerable suffering to patients. All medications, ointments applied to its surface cause acute intolerable exacerbation of pain. Medications to treat the ulcer are selected according to the stage of wound process. Sometimes one has to change several dozens of ointments, creams, powders to achieve positive result. Arterial blood pressure should be managed in the course of Martorell ulcer treatment.
More pictures of the treatment outcome of Martorell ulcer in our clinical you can find here.
