SHM's Clinical Quick Talks-Uncommon Ischemic Wounds

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Dr. Joel Steinberg’s document titled "Uncommon Ischemic Wounds" addresses two rare types of ischemic ulcers: Raynaud’s ulcers and Hypertensive ischemic (Martorell’s) ulcers.<br /><br />**Raynaud's Ulcers:**<br />Raynaud’s ulcers predominantly occur at the tips of the digits due to mechanisms including arteriolar spasm and later, advanced disease characterized by fixed lumen obstruction. Raynaud’s is classified into:<br />1. Primary Raynaud’s (Raynaud’s disease/idiopathic) with no determined underlying cause.<br />2. Secondary Raynaud’s (Raynaud’s phenomenon) with identified causes such as connective tissue disorders, drugs, or occupational hand vibration. <br /><br />These ulcers are rare, emerging in advanced cases where both functional stenosis and structural vascular abnormalities develop. Raynaud’s affects about 8% of men and 11% of women. Diagnosis involves a history of chronic distal digit color changes and associated cold exposure, physical exam findings of skin breakdown, and lab tests showing positive ANA and high ESR. Treatments focus on addressing the underlying cause, using hemorrheologic drugs, and employing therapies like cardiosynchronous intermittent limb compression.<br /><br />**Hypertensive Ischemic (Martorell’s) Ulcers:**<br />These painful ulcers typically occur on the leg due to arteriolar degeneration from uncontrolled hypertension. They are rare and are diagnosed based on a history of painful leg wounds in hypertensive individuals, along with physical exam findings of dermal breakdown. Unlike venous stasis ulcers or ischemic ulcers from large artery obstruction, these ulcers result directly from prolonged high blood pressure. Imaging like arterial Doppler and duplex ultrasound may confirm the diagnosis. Treatment involves controlling hypertension, providing analgesics for pain, and local wound care such as collagenase application.<br /><br />Both conditions are rare and diagnostically distinct, requiring specialized treatments to manage underlying vascular complications and alleviate symptoms.

Asset Subtitle

Joel Steinberg

Keywords

Raynaud's ulcers

Hypertensive ischemic ulcers

ischemic wounds

arteriolar spasm

vascular abnormalities

connective tissue disorders

uncontrolled hypertension

cardiosynchronous intermittent limb compression

collagenase application

vascular complications