SUCCESSFUL COMBINATION TREATMENT OF MARTORELLA ULCERS

Fedorov Artem Vyacheslavovich, Kalitko Ilya Igorevich, Chernyaev Mikhail Viktorovich, Faybushevich Alexander Georgievich

75 years have passed since the introduction of the term "hypertensive trophic ulcer". Reports on Martorell's ulcer periodically appear in the scientific press, but this pathology continues to be poorly studied. The issues of the pathogenesis of differential diagnosis and treatment of this disease currently continue to cause discussion, which makes the study of this problem relevant. There is description in the article of a case of hypertensive ulcer pathology of legs or Martorell’s ulcers diagnostics, which are complications of long-standing and poor-controlled essential hypertension. The article describes a case of diagnosis of hypertensive ulcerative pathology of the legs or Martorell's ulcer, which are complications of prolonged and poorly controlled essential hypertension. A 64-year-old female patient complained of the presence of long-term unhealed, painful trophic ulcers in the lower third of the right shin. The onset of the disease was associated with an insect bite, which first caused redness and itching, and then the appearance of an ulcerative defect that occurred 8 months before going to the surgeon.It is known from the anamnesis that the patient suffers from arterial hypertension for a long time with maximum blood pressure values of 180/100 mm Hg. Without systemic antihypertensive therapy. In clinical and biochemical blood and urine tests — without pathology.. Ultrasound duplex scanning of the vessels of the lower extremities was performed, in which no stenotic lesions of the main arteries, as well as pathology of superficial and deep veins were detected. A sample of the leg being separated from the wound was taken for bacteriological examination to determine sensitivity to antibiotics, according to the results of which the Enterobactercloacae microorganism sensitive to ciprofloxacin was isolated. Based on complaints, anamnesis data, laboratory and instrumental methods of treatment, consultations of specialists, the diagnosis was made: Arterial hypertension of the III stage, 3rd degree, risk of cardiovascular 3.Hypertensive trophic ulcer of the right shin.. The diagnosis was confirmed histologically. Treatment tactics were developed, which included conservative therapy and surgical treatment. Conservative therapy consisted of antihypertensive drugs, a course of rheological therapy with drugs from the prostoglandin group, antibacterial therapy and local treatment of trophic ulcers. Surgical treatment consisted in excision of trophic ulcers within healthy tissues with autodermatoplasty with a split flap. Complex therapy was continued in the postoperative period. The patient was discharged on the 10th day after the operation. 24 days after the operation, a good epitalization of trophic ulcers was determined, the pain syndrome regressed, and blood pressure stabilized. The above case demonstrates the need to inform the professional medical community about the features of Martorell's ulcers and the likelihood of their occurrence.

Keywords:hypertensive ulcers of legs, Martorell’s ulcers, case report, essential hypertension