Das Ulcus hypertonicum Martorell ist ein äußerst schmerzhafter ischämischer Hautinfarkt,
meistens auf distaler bis mittlerer Höhe an der lateralen-dorsalen Seite des Unterschenkels
lokalisiert. Seine Ursache liegt in einer stenosierenden subkutanen Arteriolosklerose.
Die Diagnose wird vermutlich häufig verpasst, da das Krankheitsbild in der medizinischen
Lehre weitgehend fehlt. Die Verwechslung mit einem Pyoderma gangraenosum kann therapeutische
Fehlentscheidungen nach sich ziehen.
Abstract
Martorell hypertensive ischemic leg ulcer (HYTILU) is a skin infarction of the lower
leg caused by subcutaneous arteriosclerosis. Most often, the rapidly progressive ulceration
occurs on the laterodorsal lower leg or over the Achilles tendon. The necrotizing
process at the wound edge is extremely painful and often rapidly progressive. The
wound margin is sometimes black and sometimes livid and undermined, which can make
it difficult to distinguish from pyoderma gangraenosum. In histology pathologic arterioles
with a thickened vessel wall and a narrow lumen are seen at the dermal-subcutaneous
junction. In 75 % of histological sections, miniaturized medial calcinosis can be
found. Subendothelial hyalinosis with reduced cell density of the vessel wall is a
very specific histological feature of hypertensive arteriolosclerosis. 100 % of affected
individuals have arterial hypertension and 60 % have type 2 diabetes mellitus. The
treatment of Martorell HYTILU is empiric. There are virtually no comparative randomized
controlled clinical trials. Small-surface, superficial wounds resulting from Martorell
HYTILU are best debrided with restraint, and the refreshed wound surface is covered
with punch grafts from the thigh. Large and deep wounds are excised down to the fascia,
the wound surface is brought to granulation with Negative Pressure Wound Treatment,
and then covered with a split-thickness skin graft. Skin grafts can be used already
at the beginning of wound management. For critically ill patients with a maximally
extensive and progressive Martorell HYTILU, daily infusion of sodium thiosulfate can
improve the healing potential and pain. According to current understanding, sodium
thiosulfate has a beneficial hemorreological effect, and decalcifies the arteriolar
wall. It is particularly important that the diagnosis of Martorell HYTILU is not confused
with pyoderma gangraenosum at the start of therapy because the therapies are completely
different.
Schlüsselwörter
Ulcus hypertonicum Martorell - Hautinfarkt - Arteriolosklerose - Mediakalzinose -
Calciphylaxis - medial calcinosis
Keywords
Martorell hypertensive ischemic leg ulcer - skin infarction - arteriolosclerosis -
calciphylaxis
