A Martorell ulcer is a painful ulceration of the lower leg associated with diastolic arterial hypertension. It was first identified by the Spanish cardiologist Fernando Martorell in 1945, who characterized this ulcer as ‘hypertensive ischaemic ulcers’ or ‘hypertensive leg ulcers’.
A Martorell ulcer occurs in patients with long-standing hypertension, usually women over 60 years old. Arterial hypertension is present in 95% to 100% of cases, and diabetes has been reported in up to 60% of patients. Notably, in 5% to 10% of patients, diabetes was reported as the unique cause. Martorell was originally described as occurring in females, aged 50 to 70 years, with a history of hypertension. However, newer studies cannot confirm a female preponderance.
The original description of Martorell ulcers and the subsequently reported cases showed that the clinical pattern and wound history were very similar from one series to another. The lesion initially appears as small, painful blister(s) that may or may not be associated with trauma. A martorell ulcer starts as a rapidly developing painful, purpuric, necrotic, and finally ulcerated lesion on the antero-lateral side of the leg or on the posterior side of the ankle, including on the Achilles tendon, surrounded by a red purpuric margin spreading regularly and centrifugally. The second clinical characteristic of a Martorell ulcer is extreme pain, more severe than would be expected for the size of the ulcer. Healing occurs is between 3 to 11 months. According to the initial definition of a Martorell ulcer, the existence of significant peripheral arterial occlusive disease (PAOD), should be an excluding criterion for this diagnosis. However, venous or arterial insufficiencies occur far more commonly in the elderly. A Martorell ulcer result from a micro-angiopathic process.
Prevention relies on the correct management of hypertension and avoiding non-selective β-blockers, which will lower skin perfusion pressure. Treatment of the ulcer involves awareness and early correct diagnosis, adequate control of both blood pressure and diabetes, management of infection, and wound care.
1. How often do you deal with people with diabetes who also have complications?
2. How often do you deal with patients with hypertension who have complications?
3. What is the severity of these complications?
4. How often do your patients with diabetes complain of pain in their lower limbs?
5. Who attends your clinic more: men or women? Younger or older?
6. What is the rate of death among your patients with both CVD and patients?
7. Describe the psychological state of your patients with severe complications.
8. Describe your diagnostic protocol for CVD in patients with diabetes.
9. Describe your diagnostic protocol for patients with ulcers in their lower limbs.
10. Who handles your patients with lower limb ulcers?
11. What are your prophylactic measures for lower limb ulcers in patients with CVD and diabetes?
Information about the discussion leader
Dr. Maksym Prystupiuk, MD, PhD, Vascular Surgeon, Assistant Professor at the Department of Surgery of the Bogomolets National Medical University, Kyiv, Ukraine.
Dr. Prystupiuk graduated with honours from the Bogomolets National Medical University with a specialization in Surgery. During his residency Dr. Prystupiuk defended his master's thesis on the topic of ‘Surgical Treatment of Diabetic Foot Syndrome in View of Diagnostic Criteria’, and received master's degree in Surgery. He conducted and defended his PhD thesis at the Department of Surgery on the topic of ‘Surgical Treatment of Patients with Neuroischemic Form of Diabetic Foot Syndrome’. His research and clinical duties are focused on treatment of vascular diseases, purulent-septic surgery, complications of diabetes mellitus of lower limbs and reconstructive surgery.
Since 2011, Dr. Prystupiuk is the Medical Expert of the International Diabetes Association of Ukraine.
Since 2017, Dr. Prystupiuk is the Medical Chief Officer of the International Ice Hockey Federation.
Since 2018, Dr. Prystupiuk is a writing group expert for the World Heart Federation Roadmap on the prevention of cardiovascular disease among people with diabetes.
Since 2018, Dr. Prystupiuk is an expert reviewer for IDF's Taking Diabetes to Heart report.