Successful Treatment of Morel-Lavallée Lesion of the Back With Transcutaneous Transmyofascial Bolstered Progressive Tension Suturing

Abstract

The authors describe their experience in successfully treating an isolated Morel-Lavallée lesion of the lumbar spine after delayed presentation. In addition to thorough irrigation, debridement, and pseudo-capsulectomy, surgical management included transcutaneous transmyofascial bolstering with a progressive tension suturing technique to close the cavity over drains in a “quilting” fashion. This was followed by 6 days of incisional wound vacuum treatment and 13 days of drainage through 2 Jackson-Pratt drains. At 6-month follow-up, the patient noted resolution of pain and return to baseline level of functioning. No evidence of recurrence was noted. The Morel-Lavallée lesion of the low back represents a difficult soft tissue injury to treat with substantial risk of complications and recurrence. Diagnosing and treating physicians should be familiar with common injury mechanisms and clinical presentations, as well as a variety of nonoperative and operative treatment options. [ Orthopedics . 2019; 42(4):e399–e401.]

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

“…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 .…”

“… 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 , 53 , 54 , 55 , 56 , 57 Kalaria et al successfully applied liposuction cannulas to destroy the cavity of the lesion. 58 Li et al successfully applied a minimally invasive incision in combination with loop drainage technique to treat Morel‐Lavallée lesion of the lower extremity and named this technique as nose ring drainage technique.…”