Percutaneous Quilting Technique for the Treatment of Morel-Lavallée Lesion

Kumar, Gautam; Pandiyan, Alagu; Theruvil, Bipin

doi:10.1007/s43465-020-00097-4

Cited by 6 publications

(7 citation statements)

References 26 publications

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“…Kumar et al treated 22 MLL patients with a percutaneous quilting technique without adverse events. In this study, the skin and deep fascia were tightly sutured with heavy, nonabsorbable, non-braided sutures, and a suction drain tip was used as a marker to ensure that the sutures engaged the deep fascia to the skin (19). Li et al demonstrated a minimally invasive incision and a nose ring drainage technique for treating lower limb MLLs.…”

Section: Discussionmentioning

confidence: 99%

The treatment of a Morel-Lavallée lesion of the thigh with incision and drainage along with tissue debridement and a surgically placed drain: A case report and literature review

Chen²,

Ma³

et al. 2023

Front. Surg.

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BackgroundA Morel-Lavallée lesion (MLL) is a rare closed degloving injury that usually occurs around the hips and is associated with pelvic fractures after high-energy trauma, which is commonly overshadowed by other severe post-traumatic manifestations. An isolated MLL, mostly caused by low-energy violence, is even rarer. Thus, the rates of misdiagnosis and missed diagnosis are often high. In this case report and literature review, we review the pathophysiology, clinical manifestations, imaging data, and treatment of this lesion to increase awareness of this rare disease.Case reportWe report the case of an isolated MLL in the right thigh caused by trauma, which happened to be one of missed diagnosis both at the initial visit and at the return visit of the patient, with a significant sign of a mass on MRI. Given the size of the lesion, open debridement and irrigation were adopted to treat the lesion, and the patient recovered well post-operatively.ConclusionYoung surgeons should pay attention to the MLL with sufficient recognization to avoid missed diagnosis and misdiagnosis. Comprehensive physical examination and imaging data play important roles in the diagnosis of MLL. In the early stages of this injury, a detailed history review combined with physical examination and MRI, can reduce the rates of missed diagnosis and misdiagnosis. The choice of the therapeutic scheme depends on the size and severity of the lesion. For an isolated MLL, compared with conservative treatments, we suggest that incision and drainage, along with tissue debridement and a surgically placed drain, will reduce the rates of infection and recurrence.

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Section: Discussionmentioning

confidence: 99%

The treatment of a Morel-Lavallée lesion of the thigh with incision and drainage along with tissue debridement and a surgically placed drain: A case report and literature review

Chen²,

Ma³

et al. 2023

Front. Surg.

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“…13 Nickersen et al reviewed 79 patients with ML lesion and 56% of these patients suffered from high-energy mechanisms of trauma, 14 whereas 95% of the patients in their 22-patient case series had ML lesions secondary to MVC. 18 Female sex and a body mass index > 25 are proposed risk factors, presumably because of the increased fat in predisposed regions. 23 Muneer et al described a 31.5% incidence of ML lesion in obese patients with BMI ≥30.…”

Section: Discussionmentioning

confidence: 99%

“…Nine case reports/series, 1,[4][5][6][7][8][9][10][11] seven retrospective studies, 2,[12][13][14][15][16][17] three prospective studies, [18][19][20] eight review articles, 3,[21][22][23][24][25][26][27] and one systematic review 28 fulfilled our inclusion criteria. The characteristics of the prospective and retrospective studies included in this review pertaining to the ML lesion, the mechanism of injury, treatment received and its outcome are summarized in Table 1.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…11,14,19,23 Sclerosants cause fibroblast growth and adherence between the layers of the capsule. 18 Bansal et al reported that of the 16 patients who underwent treatment using doxycycline sclerodesis and compression bandaging, only one patient, who was non-compliant to compression bandage application, failed the therapy. 19 Shen et al also demonstrated an overall success rate of 95.7% for sclerodesis in the treatment of ML lesions.…”

Section: Managementmentioning

confidence: 99%

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Morel-Lavallée lesion: An uncommon internal degloving injury in trauma patients

Pothiawala

Miranda

Tsai

et al. 2023

Trauma

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Introduction Morel-Lavallée (ML) lesion is an uncommon closed internal degloving soft tissue injury seen in patients with blunt trauma. As it often takes days to weeks after trauma to develop, it may go undiagnosed and can be missed in up to 44% of the cases. Methodology A comprehensive literature search was performed using various databases till August 2022. Twenty-eight articles related to the pathophysiology, clinical presentation, diagnosis, treatment or complications of ML lesions were included and summarized in this review. Discussion Shearing forces lead to separation of the skin and subcutaneous tissues from the fascia superficial to underlying muscles, and collection of fluid in this space leads to development of a palpable fluctuant swelling. The most common etiologies were motor vehicle crashes, falls and contact sports. It usually forms adjacent to a bony protuberance. Common symptoms include pain and swelling over the injured area, either presenting acutely after the trauma, or developing few days to weeks after the injury. It is often misdiagnosed as muscle contusion or hematoma, abscess or neoplasm. Use of bedside ultrasound and computed tomography (CT) can aid in its identification, but magnetic resonance imaging (MRI) is the imaging modality of choice. Depending on the size and severity of the lesion, as well as presence or absence of a capsule, definitive management can be conservative or surgical. Conclusion ML lesion is often undiagnosed during initial presentation of a trauma patient, and emergency physicians and trauma surgeons should be aware of the possibility of occurrence of this injury. MRI is the imaging modality of choice, and the presence or absence of a capsule is an important imaging finding that guides appropriate therapy. Early diagnosis and management will help prevent long-term morbidity and complications in these patients.

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“…The traditional method is irrigation and drainage through one or more limited small incisions 28,51 . It has also been reported that progressive tension sutures, quilting, fibrin sealant, and low suction drains can successfully achieve the above goal 14,17,18,49,52–57 . Kalaria et al successfully applied liposuction cannulas to destroy the cavity of the lesion 58 .…”

Section: Methodsmentioning

confidence: 99%

The Morel‐Lavallée Lesion: Review and Update on Diagnosis and Management

Yang

Tang

2023

Orthopaedic Surgery

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Morel‐Lavallée lesion is a closed soft tissue degloving injury usually associated with high‐velocity trauma. It most commonly occurs in the thigh, hip, and pelvis. Because such lesions are prone to a missed or delayed diagnosis, it may present a potential risk of infection at the fracture site once it progresses. Therefore, timely identification and management of Morel‐Lavallée lesion is crucial. Moreover, there are no relevant guidelines for the treatment of Morel‐Lavallée lesion. Based on the above facts, we reviewed the etiology, epidemiology, pathophysiology, clinical presentation, imaging features, treatment, prognosis, and complications of Morel‐Lavallée lesion with the aim of providing a comprehensive overview of Morel‐Lavallée lesion, increasing awareness of this injury among orthopaedic surgeons, and thus providing a management algorithm that can be applied to this injury.

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Percutaneous Quilting Technique for the Treatment of Morel-Lavallée Lesion

Cited by 6 publications

References 26 publications

The treatment of a Morel-Lavallée lesion of the thigh with incision and drainage along with tissue debridement and a surgically placed drain: A case report and literature review

The treatment of a Morel-Lavallée lesion of the thigh with incision and drainage along with tissue debridement and a surgically placed drain: A case report and literature review

Morel-Lavallée lesion: An uncommon internal degloving injury in trauma patients

The Morel‐Lavallée Lesion: Review and Update on Diagnosis and Management

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