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SURGICAL APPROACH TO ATYPICAL WOUNDS (CLINICAL CASES). SUBCUTANEOUS ISCHEMIC ARTERIOLOSCLEROSIS (MARTORELL ULCER, CALCIPHYLAXIS, EUTROPHICATION)

TOMISLAV NOVINŠČAK ; Čakovec General Hospital, Department of Surgery, Vascular Division, Zagreb, Croatia
MARINKO FILIPOVIĆ ; Čakovec General Hospital, Department of Surgery, Vascular Division, Zagreb, Croatia
EDITA JOZINOVIĆ ; Čakovec General Hospital, Department of Surgery, Vascular Division, Zagreb, Croatia
MARIJAN ŽVORC ; Čakovec General Hospital, Department of Surgery, Vascular Division, Zagreb, Croatia
MARINA GRADIŠER ; Department of Medicine, Division of Endocrinology, Čakovec, Croatia
SLAVKO GAŠPAROV ; Merkur University Hospital, Clinical Department of Pathology and Cytology, Zagreb, Croatia

Abstract

Atypical wounds are probably the most delicate modern medicine topics as well as the most demanding surgical issue. Recently, we submitted an original report of two similar atypical vascular cases at our surgery department. Both presented a rare type of atypical, potentially fatal, vascular illness due to acute ischemic subcutaneous arteriolosclerosis. Because of the strikingly similar common pathophysiological features, Martorell hypertensive
ischemic leg ulcer (HYTILU) and calciphylaxis require identical approach and therapy, both systemic and surgical. Even an experienced clinician can easily confuse it with other atypical wounds, namely pyo derma gangrenosum, which due to the corticosteroid induced immunodeficiency can be detrimental, since the two different approach strategies are required. Based on typical localization, necrotic painful skin necroses, progressive local deterioration, often difficult secondary infections along with long term hypertension and diabetes history could elucidate suspicion of ischemic subcutaneous arteriosclerosis. Hypertension (and often diabetes), local findings and histologically proven subcutaneous arteriolosclerosis are mandatory to make the diagnosis. Rapid local amelioration following correct treatment approach additionally confirms the presumed diagnosis. Besides the minutely repetitive surgical debridement, negative wound pressure therapy and split skin transplantation, one should consider systemic medication (analgesics, antioxidants, LMWH, sodium thiosulfate and antibiotics). Considering the cases presented, opportune decisions along with moderate aggressive and modern holistic surgical approach should inevitably resolve hard to heal atypical wounds.

Keywords

atypical wound; Martorell hypertensive ischemic leg ulcer; calciphylaxis; subcutaneous ischemic arteriolosclerosis

Hrčak ID:

98743

URI

https://hrcak.srce.hr/98743

Publication date:

25.2.2013.

Article data in other languages: croatian

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