Conservative treatment of a chronic Morel-Lavallée lesion: a case report
DOI:
https://doi.org/10.5281/zenodo.897714Keywords:
Morel-Lavallée lesion, Closed deglovement injury, Distal thighAbstract
AIM: The Morel-Lavallée lesion was first described by a French physician in 1863. These lesions are post-traumatic closed soft-tissue degloving injuries characterized by separation of the subcutaneous fat from the underlying fascia induced by violent shear stress. Morel-Lavallée lesions are commonly associated with high-energy trauma and predominantly seen in women. The aim of this case report is to increase awareness to these relatively rare but potentially dangerous and frequently missed post-traumatic lesions. CASE PRESENTATION: A 51-year old woman was repatriated to the emergency department one week after a high-energy traffic accident abroad. Approximately one-month post trauma, during hospitalization on our traumatology department, the patient complained of local pain on the lateral side of the right distal thigh. Clinical evaluation showed a tumor on the distal thigh characterized by a fluctuant mass during palpation. Ultrasound examination described a Morel-Lavallée lesion of circa 9.2x7.5cm. Since the pain only appeared during exercise, a conservative treatment by occasionally bandaging, watchful waiting and careful monitoring were initiated. The symptoms slowly improved and conservative treatment was maintained. CONCLUSION: Morel-Lavallée lesions are post-traumatic closed soft-tissue degloving injuries that are often missed to diagnose. These lesions can be complicated by skin necrosis and infection. There are currently no evidence-based guidelines in the medical literature on the treatment of Morel-Lavallée lesions. Overall, we agree that Morel-Lavallée lesions need close monitoring and evaluation until final healing occurs. Early recognition and optimal management can save patients from undesirable complications and need for complex open surgical treatment.
References
2. Tseng S, Tornetta P. Percutaneous management of Morel-Lavallee lesions. J Bone Joint Surg Am. 2006;88(1):92–96.
3. Vico PG. Morel-Lavallée syndrome. Eur J Plast Surg. 2000;23(1):45–48.
4. Nickerson TP, Zielinski MD, Jenkins DH, Schiller HJ. The Mayo Clinic experience with Morel-Lavallée lesions: establishment of a practice management guideline. J Trauma Acute Care Surg. 2014;76(2):493–497.
5. Scolaro JA, Chao T, Zamorano DP. The Morel-Lavallée Lesion: Diagnosis and Management. J Am Acad Orthop Surg. 2016;24(10):667–672.
6. Greenhill D, Haydel C, Rehman S. Management of the Morel-Lavallée Lesion. Orthop Clin North Am. 2016;47(1):115–125.
7. Costopoulos CL, Sachs IC, Graf KW, Kauffman RW, Mehta S. Lower Limb Morel-Lavallée Lesion Treated With Short-Stretch Compression Bandaging. Am J Orthop (Belle Mead NJ). 2017;46(4):E213–218.
8. Ciaschini M, Sundaram M. Radiologic case study. Prepatellar Morel-Lavallée lesion. Orthopedics. 2008;31(7):626, 719–721.
9. Parra JA, Fernandez MA, Encinas B, Rico M. Morel-Lavallée effusions in the thigh. Skeletal Radiol. 1997;26(4):239–241.
10. Bonilla-Yoon I, Masih S, Patel DB, White EA, Levine BD, Chow K, Gottsegen CJ, Matcuk GR Jr. The Morel-Lavallée lesion: pathophysiology, clinical presentation, imaging features, and treatment options. Emerg Radiol. 2014;21(1):35–43.
11. Neal C, Jacobson JA, Brandon C, Kalume-Brigido M, Morag Y, Girish G. Sonography of Morel-Lavallee lesions. J Ultrasound Med. 2008;27(7):1077–1081.
12. Carlson DA, Simmons J, Sando W, Weber T, Clements B. Morel-lavalée lesions treated with debridement and meticulous dead space closure: surgical technique. J Orthop Trauma. 2007;21(2):140–144.
Downloads
Published
How to Cite
Issue
Section
License
Articles in BioMedicine and Surgery are published under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International license. Full text of Attribution-NonCommercial-NoDerivatives 4.0 International license can be viewed at https://creativecommons.org/licenses/by-nc-nd/4.0/legalcode.
