Owrzodzenie Martorellego, inaczej nadciśnieniowe owrzodzenie nóg (ang. hypertensive leg ulcer, HLU), to rzadko występująca odmiana trudno gojących się ran w obrębie goleni, której przyczyną jest labilne nadciśnienie tętnicze.
Owrzodzenie Martorellego występuje najczęściej u pacjentów po 50. roku życia z przewlekłym nadciśnieniem tętniczym. U chorych często występują choroby współistniejące w postaci cukrzycy typu II oraz otyłości. Owrzodzenie Martorellego częściej dotyka kobiety niż mężczyzn.
Uważa się, że wrzód Martorellego powstaje w następstwie zwężenia małych naczyń krwionośnych w obrębie skóry, co prowadzi do zaburzeń przepływu krwi i miejscowych zawałów, a następnie do obumarcia tkanek. Owrzodzenia mogą powstawać nawet w następstwie niewielkich urazów.
Obraz kliniczny
Obraz kliniczny owrzodzenia Martorellego obejmuje sinicę siatkowatą oraz trudno gojące się rany w obrębie goleni, w obszarze tuż nad kostką lub nad ścięgnem Achillesa. U ok. połowy pacjentów zmiany chorobowe mają charakter obustronny.
Początkowo zmiany przybierają postać ciemnych plam lub pęcherzy, które następnie ulegają owrzodzeniu. Zmiany maja nieregularne kształty. Ich brzegi są wyraźnie odgraniczone, o czerwonosinym zabarwieniu. W łożysku wrzodu wykształca się tkanka martwicza. Zmiany mogą mieć różną grubość – od zmian powierzchownych aż po całą głębokość tkanki podskórnej. Zmiany mają tendencję do szerzenia się, a nie do pogłębiania, ponieważ zaburzenia tętnicze nie obejmują naczyń krwionośnych w głębszych warstwach tkanki.
Owrzodzenie Martorellego wywołuje bardzo silne dolegliwości bólowe (pacjenci często opisują ból jako rozdzierający), niewspółmierne do rozległości rany.
Leczenie
Terapia owrzodzenia Martorellego obejmuje leczenie miejscowe w połączeniu z farmakoterapią.
Stosuje się leki zmniejszające nadciśnienie i rozkurczające naczynia krwionośne, takie jak blokery kanału wapniowego, inhibitory ACE oraz specyficzne beta-blokery. Badania wskazują, że nawet nieznaczne zmniejszenie ciśnienia tętniczego może mieć duży wpływ na ograniczenie dolegliwości bólowych i poprawę gojenia.
W leczeniu miejscowym stosuje się chirurgiczne oczyszczanie w połączeniu z terapią kompresyjną oraz terapią NPWT. Leczenie może być znacząco utrudnione z powodu dużego nasilenia dolegliwości bólowych pacjenta. W przypadku rozległych owrzodzeń konieczne może być przeprowadzenie przeszczepu skóry.
Źródła:
M. Mansour, A. Alavi, „Martorell ulcer: chronic wound management and rehabilitation”, “Chronic Wound Care Management and Research” 2019, 6: 83-88.
Przeczytaj także: Czy śląska glina lecznicza ma właściwości bakteriobójcze? Trwają badania
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