Ulcus hypertonicum Martorell

Zusammenfassung

Das Ulcus hypertonicum Martorell (UHM) ist eine häufige Differenzialdiagnose bei schmerzhaften Unterschenkelulzera. Zugrunde liegend findet sich bei Patienten mit langjährig bestehender arterieller Hypertonie eine stenosierende Arteriolosklerose in der Subkutis, welche im Endstadium zum Hautinfarkt führt. Die histologischen Veränderungen sind beim UHM und dem Krankheitsbild der Kalziphylaxie sehr ähnlich. Daher liegt die Hypothese nahe, dass die beiden Entitäten Varianten derselben Erkrankung sind. Klinisch findet sich beim UHM ein mit invalidisierenden Schmerzen einhergehendes Ulkus am laterodorsalen Unterschenkel oder über der Achillessehne. Aufgrund seines typischerweise entzündlich-livid veränderten Wundrands und einer Tendenz zur Größenzunahme wird das klinische Bild nicht selten als Pyoderma gangraenosum oder nekrotisierende kutane Vaskulitis verkannt, immunsuppressiv behandelt und eine Biopsie und chirurgische Therapien vermieden. Dabei wäre beim UHM die Nekrosektomie mit anschließender Spalthauttransplantation die Behandlung der Wahl.

Abstract

Martorell hypertensive ischaemic leg ulcer (HYTILU) represents an important differential diagnosis of painful leg ulcerations. Stenotic subcutaneous arteriolosclerosis in patients with long-standing arterial hypertension finally leads to skin infarction. The typical histological changes are very similar in Martorell HYTILU and calciphylaxis. This raises the hypothesis that the two entities may have a common pathogenesis. Martorell HYTILU presents as an extremely painful ulcer that is regularly located at the laterodorsal lower leg or at the Achilles tendon. Because of its inflammatory and violaceous wound edges and its tendency to progression, clinicians unaware of the diagnosis Martorell HYTILU might misdiagnose pyoderma gangrenosum or necrotising cutaneous vasculitis start an immunosuppressive treatment and avoid surgical diagnostic and therapeutic procedures. Instead, necrosectomy and split skin grafting are the treatment of choice for Martorell HYTILU.

Schlüsselwörter

Ulcus hypertonicum Martorell - subkutane Arteriolosklerose - Pyoderma gangraenosum - Kalziphylaxie - Ulkuschirurgie - Spalthauttransplantation

Key words

Martorell hypertensive ischaemic leg ulcer - subcutaneous arteriolosclerosis - pyoderma gangrenosum - calciphylaxis - leg ulcer surgery - split-skin grafting

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