Martorell hypertensive leg ulcer
Alerts and Notices
Synopsis
Martorell ulcer is thought to be due to subcutaneous arteriosclerosis that develops as a result of increased peripheral vascular resistance occurring in the setting of chronic hypertension. This leads to diminished arteriolar blood flow to the skin, followed by ischemia and ulceration.
Martorell ulcers are often underdiagnosed: a prospective cohort of 59 patients demonstrated a mean duration before diagnosis of 11 weeks and the wound extending to a mean surface area of 19 cm.
Related topic: Ischemic ulcer
Codes
ICD10CM:L97.909 – Non-pressure chronic ulcer of unspecified part of unspecified lower leg with unspecified severity
SNOMEDCT:
238795008 – Hypertensive leg ulcer
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Pyoderma gangrenosum – May be difficult to distinguish. A deep wedge biopsy can correctly diagnose a Martorell ulcer, whereas superficial biopsies may demonstrate inflammatory cell infiltrates and lead to an incorrect diagnosis of pyoderma gangrenosum.
- Calciphylaxis – Associated with chronic renal failure or secondary hyperthyroidism.
- Necrotizing vasculitis (see vasculitis, polyarteritis nodosa) – Purpuric lesions, usually bilateral.
- Sickle cell vasculopathy
- Venous ulcer – Shallow with granulation tissue base.
- Arterial ulcer – Associated with peripheral artery disease; often presents on anterior shin with a deep, punched-out appearance.
- Squamous cell cancer
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Therapy
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References
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Last Reviewed:02/20/2019
Last Updated:03/04/2019
Last Updated:03/04/2019
Martorell hypertensive leg ulcer