Martorell ulcer: chronic wound management and rehabilitation

Mark Mansour,1 Afsaneh Alavi21Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; 2Division of Dermatology, Department of Medicine, Women’s College Hospital, University of Toronto, Toronto, Ontario, CanadaAbstract: Martorell hypertensive ischemic leg ulcers (HYTILU) are a rare lower extremity wound which exclusively occurs in patients with long-standing hypertension. Its pathophysiology is due to local skin infarctions caused by arteriolosclerosis of the dermis and subcutis. The differential diagnosis for a lower extremity wound is broad; however, Martorell HYTILU must primarily be distinguished from calciphylaxis and pyoderma gangrenosum. Diagnosis is accomplished by its clinical presentation, traditionally on the dorsolateral leg, its comorbidity with chronic arterial hypertension, and findings of arteriolosclerosis on histopathology. Given its rarity, there has been very little research conducted on interventions for its management and rehabilitation. Treatment primarily involves analgesia and surgical intervention usually with split-thickness skin grafting. The current review aims to summarize the current evidence on Martorell HYTILU and provide recommendations on its management.Keywords: Martorell ulcer, hypertensive ischemic leg ulcer, atypical ulcer, wound healing