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Martorell hypertensive leg ulcer
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Martorell hypertensive leg ulcer

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Contributors: Catherine Wang, Susan Burgin MD
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Synopsis

Martorell hypertensive leg ulcer is a painful ischemic ulcer on the lower extremity caused by long-standing, uncontrolled hypertension. Many patients also have diabetes mellitus. This condition was previously thought to affect women aged 50-70 years, but an older mean age and lack of female predominance have been described in more recent studies.

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

Look For

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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

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed: 02/21/2019
Last Updated: 03/05/2019
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Martorell hypertensive leg ulcer
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Martorell hypertensive leg ulcer : Painful skin lesions, Hypertension, Lower limb
Copyright © 2019 VisualDx®. All rights reserved.