title: Martorell hypertensive ischemic leg ulcer: a model of ischemic subcutaneous arteriolosclerosis.
abstract: OBJECTIVE
  To better define the diagnosis and treatment of Martorell hypertensive ischemic leg ulcer (HYTILU) and to compare Martorell HYTILU with calciphylaxis (calcific uremic arteriolopathy) and nonuremic forms of calciphylaxis.
  
  
  METHODS
  Retrospective study from 1999 through 2007.
  
  
  METHODS
  Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.
  
  
  METHODS
  Of 330 patients with leg ulcers, 31 had a clinical diagnosis of Martorell HYTILU confirmed by dermatopathologic examination.
  
  
  METHODS
  Clinical features, suspected diagnosis at initial presentation, cardiovascular risk factors, findings from vascular examination and histologic analysis, specific medical and surgical management, and outcome.
  
  
  RESULTS
  Of the 31 patients, all presented with 1 or multiple painful necrotic skin ulcers on the laterodorsal part of the leg, with bilateral involvement in 16 of 31 cases (52%), and 16 were referred with suspected pyoderma gangrenosum. All patients had arterial hypertension, and 18 (58%) had diabetes. All patients had subcutaneous stenotic arteriolosclerosis on histologic analysis, with medial calcification in 22 of 31 of cases (71%). Martorell HYTILU, calciphylaxis, and nonuremic forms of calciphylaxis shared identical histologic features. Of the 31 patients, 29 (94%) were successfully treated with surgical debridement and split-thickness skin grafting. Three patients (9%) died of sepsis, 2 of whom were undergoing immunosuppressive treatment for wrongly diagnosed pyoderma gangrenosum.
  
  
  CONCLUSIONS
  Ischemic subcutaneous arteriolosclerosis is the hallmark of Martorell HYTILU, calciphylaxis, and the nonuremic forms of calciphylaxis. All patients are hypertensive and approximately 60% are diabetic. Martorell HYTILU can easily be confused with pyoderma gangrenosum, which can be detrimental, since the 2 diseases require a completely different treatment strategy.
authors.affiliation: Department of Dermatology, University Hospital of Zurich, Switzerland. juerg.hafner@usz.ch
authors.forename: Jürg
authors.initials: J
authors.lastname: Hafner
authors.forename: Stephan
authors.initials: S
authors.lastname: Nobbe
authors.forename: Hugo
authors.initials: H
authors.lastname: Partsch
authors.forename: Severin
authors.initials: S
authors.lastname: Läuchli
authors.forename: Dieter
authors.initials: D
authors.lastname: Mayer
authors.forename: Beatrice
authors.initials: B
authors.lastname: Amann-Vesti
authors.forename: Ruedi
authors.initials: R
authors.lastname: Speich
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmid
authors.forename: Günter
authors.initials: G
authors.lastname: Burg
authors.forename: Lars E
authors.initials: LE
authors.lastname: French
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D050379:Arteriolosclerosis / Q000150:complications* / Q000473:pathology; D002115:Calciphylaxis / Q000150:complications* / Q000473:pathology; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis; D007511:Ischemia / Q000150:complications* / Q000473:pathology; D007866:Leg / Q000098:blood supply*; D007871:Leg Ulcer / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000473:pathology; D010147:Pain Measurement; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016038:Skin Transplantation / Q000379:methods*; D040521:Subcutaneous Tissue / Q000473:pathology; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
chemical_list: D000900:Anti-Bacterial Agents; D000959:Antihypertensive Agents