Martorell's Ulcer Revisited

Steven Davison, MD, DDS, Edward Lee, MD, Edward D Newton, MD

Disclosures

Wounds. 2003;15(6) 

In This Article

Abstract and Introduction

The authors describe a case of Martorell's ulcer that is classic in presentation, pathology, and management. Although rare, this disease is important to understand in order to hasten diagnosis and treatment and, thereby, reduce the time of disability for the patient.

In the 1940s, Martorell[1] described a unique, ischemic ulcer of the leg as a complication of hypertension. Hines and Farber[2] subsequently confirmed the existence of this ulcer and reported 11 cases of Martorell's ulcers. The classic presentation of this ulcer includes a superficial ulcer on the lower extremity, poorly controlled or long-standing diastolic arterial hypertension in both the extremities, bilateral symmetry that may manifest as a pigmented lesion on the contralateral leg, a history of minimal trauma, which may not be remembered, and moderate to severe pain often out of proportion to the size of the ulcer.[3] The lesion is more common in female patients than in male patients, rarely seen in African Americans, and is most often seen in women between the ages of 55 and 65.[4] These lesions are refractory to local wound care or more aggressive therapy and may progress by irregular extension of the ischemic area. The diagnosis also requires that other causes of lower-extremity ulcers, such as arterial insufficiency, venous insufficiency, and systemic disease, be excluded.[5]

These lesions also have a characteristic appearance on biopsy according to Hines and Farber. There is arteriolar stenosis, hyalinization between the endothelium and the elastica interna, and an increase in the size and number of nuclei indicating endarterial proliferation.

Here the authors describe a case that is classic in presentation, pathology, and management. Although rare, this disease is important to understand in order to hasten diagnosis and treatment and, thereby, reduce the time of disability for the patient.

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