Do you know about hypertensive ischemic ulcers?

In the field of cardiovascular disease, there is a special and relatively rare condition - hypertensive ischemic ulcer, also known as Martorell's ulcer. This type of ulcer occurs mainly in patients whose blood pressure has been poorly controlled for a long time, especially in the lower limbs. Although its incidence is lower than other cardiovascular diseases, it still occupies a place among hospitalized patients with lower extremity ulcers, accounting for approximately 15%.

What is a hypertensive ischemic ulcer?

A hypertensive ischemic ulcer is named after Spanish cardiovascular surgeon Fernando Martorell, who first reported the condition in 1945. At the time, he made it clear that such patients were characterized by poorly controlled blood pressure and that the ulcers were not directly related to chronic venous insufficiency (CVI) or peripheral arterial disease (PAD). A year later, Hines and Farber of the Mayo Clinic further discovered that this type of ulcer was closely related to the hypertrophy and stenosis of subcutaneous arterioles, hence the name hypertensive ischemic ulcer.

Although hypertension is quite common in the population, the incidence of hypertensive ischemic ulcers is relatively low. Experts believe that high blood pressure alone cannot directly cause such ulcers. It must work together with other physical factors to cause the disease. This also explains why not all patients with hypertension develop ischemic ulcers.

How should hypertensive ischemic ulcers be treated?

In terms of treatment, hypertensive ischemic ulcers require a comprehensive consideration of multiple methods. In addition to aggressive pain control, wound debridement, and skin grafting, controlling hypertension itself is key to treatment. Through comprehensive treatment and meticulous care, ulcer healing can be effectively promoted, the risk of recurrence can be reduced, and the patient's quality of life can be improved.

When we are faced with a lower extremity ulcer suspected of being caused by hypertension, a biopsy is an essential step. Although the typical clinical manifestations and history of arterial hypertension may lead us to initially suspect Martorel ulcers, painful, necrotic, well-circumscribed, red and purple edges, and rapidly progressing lower extremity ulcers may also be caused by other pathological mechanisms, such as Obliterative vasculopathy, calcium allergy, vasculitis or pyoderma gangrenosum, etc. Therefore, for the diagnosis and treatment of lateral lower limb ulcers, we need to comprehensively consider various possible factors to ensure that patients receive accurate diagnosis and treatment.

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Editor: kiki Jia