Results from surgical treatment of Morel-Lavallée lesions: prospective cohort study

Abstract

ObjectiveTo present the results from early diagnosis and delayed surgical treatment of a cohort of patients who were diagnosed with Morel-Lavallée lesions.MethodsBetween January 2006 and December 2013, we performed delayed surgical debridement on Morel-Lavallée lesions, after delimitation of the local tissue necrosis, followed by closure through second intention and/or use of grafts/flaps.ResultsAll the patients evolved with complete closure of the lesion after the delayed debridement, granulation of the operative wound and primary suturing or construction of pedunculated flaps. Three patients (50%) evolved with deep infectious processes due to the successive operative procedures.ConclusionWhatever the treatment methods used are, they should be performed in a radical manner. If not, the patient will be at risk of evolution to septicemia and death.

Morel‐Lavallee injury a case study

“…The Morel‐Lavallee lesion (MLL) was initially described by a French surgeon named Maurice Morel‐Lavallee in 1853, as a closed degloving injury where the skin and superficial fascia are traumatically separated, creating a dead space . The mechanism of injury is the application of high‐intensity forces to the body in either a direct or tangential shearing, and the effect is a separation of the skin and subcutaneous tissue from the underlying muscle fascia . When the traumatic injury occurs, there is damage to the vascular and lymphatic supply, which then leads to the accumulation of blood and lymph in the dead space generated by the separation of the superficial and deep fascia .…”

“…The material inside of the lesion creates a chronic inflammatory process. These lesions are associated with significant morbidity and mortality . Over time, there is resorption of the hemorrhagic elements, increasing the serosanguinous fluid and progressive fibrous encapsulation which hinders resorption and leads to a slow continued expansion .…”

“…[1][2][3] The mechanism of injury is the application of high-intensity forces to the body in either a direct or tangential shearing, and the effect is a separation of the skin and subcutaneous tissue from the underlying muscle fascia. 4,5 When the traumatic injury occurs, there is damage to the vascular and lymphatic supply, which then leads to the accumulation of blood and lymph in the dead space generated by the separation of the superficial and deep fascia. [5][6][7] The material inside of the lesion creates a chronic inflammatory process.…”

“…These lesions are associated with significant morbidity and mortality. 4,8 Over time, there is resorption of the hemorrhagic elements, increasing the serosanguinous fluid and progressive fibrous encapsulation which hinders resorption and leads to a slow continued expansion. 6,9 The areas most likely to suffer from Morel-Lavallee injuries are the hip/greater trochanter, anterolateral thigh, gluteal, lumbodorsal, and scapular regions.…”

“…6,9 The areas most likely to suffer from Morel-Lavallee injuries are the hip/greater trochanter, anterolateral thigh, gluteal, lumbodorsal, and scapular regions. 4,10 They are usually found adjacent to osseous protuberances. 5 In 2005, Mellado and Bencardino proposed an extensive six-stage imaging-based classification based on the shape of lesion, signal intensity on T1-and T2-weighted images, presence of fibrous capsule, contrast enhancement, and sinus tract formation capsule 11…”