Successful treatment of a Martorell’s hypertensive ischemic leg ulcer with an interprofessional approach

What is it about?

Background: Martorell’s ulcer, also known as hypertensive leg ulcer (Martorell hypertensive ischemic leg ulcer /HYTILU/) is a challenging chronic ulcer form and often underdiagnosed. Aim: To highlight the role of interprofessional teamwork in treating Martorell HYTILU ulcers. Method: Case study of a 69-year-old woman with chronic ulcers in the left ankle, identified as ischemic and Martorell HYTILU ulcers. The interprofessional team included vascular surgeons, dermatologists, plastic surgeons, a geriatrician, an infectious disease specialist, tissue viability nurses and a physiotherapist. Discussion: At first visit, ER evaluation showed palpable ADP and ATP. Cefuroxime was started, and surgical revision was assigned. After second revision, the ulcers necrotized again and became extremely painful. On second evaluation, peripheral pulses were not palpable, and the patient was referred to university hospital, where she received interprofessional care. In CTA, multilevel atherosclerotic stenoses were seen on the left limb. After revascularization, intravenous sodium thiosulfate treatment was initiated due to clinical suspicion of Martorell HYTILU ulcer and the reappearance of necrotic tissue declined. Negative pressure wound therapy (NPWT) was started, but technical challenges prevented compression therapy threatening the skin graft’s success due to leg oedema. After skin grafting, NPWT was replaced by compression therapy. After 3 months, the ulcer was healed. Conclusion: Interprofessional teamwork is essential for treating Martorell HYTILU ulcers. Regular clinical evaluations and education on leg oedema treatment are also crucial. Implications for clinical practice: Clear, concise, and concrete instructions aid the work of the receiving care unit.

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