Missed Massive Morel-Lavallee Lesion

Abstract

A Morel-Lavallee lesion (MLL) involves posttraumatic fluid collection around the greater trochanter. Many cases of MLL are missed at the initial evaluation, and the treatment of MLL is not well established. We present two cases in which MLL was missed at the initial evaluation. Case 1. A 65-year-old man was run over by a parade float. There was subcutaneous hematoma around the left greater trochanter, and no fracture was found. We diagnosed this injury as MLL on the 7th day after the trauma. Although we performed percutaneous drainage, the injured area was infected. Case 2. A 57-year-old man was hit by a train in a factory. There was an iliac wing fracture, but an MLL was not initially recognized. On the 6th day after the trauma, when performing open reduction and internal fixation for the iliac fracture, we recognized the lesion and performed percutaneous drainage simultaneously. This lesion also became infected. In these two cases, the wounds finally healed after a long duration of treatment. We suggest that it is important to keep this injury in mind and debride the lesion early and completely in the treatment course.

The importance of morel-lavallee lesion in medicolegal evaluation: a case report

“…The Morel-Lavallee Lesion (MLL) was first described by the French Doctor Maurice Morel-Lavallee in 1863 [1][2][3][4][5]. The blunt trauma or tangential force to the fascia results in tearing of the trans-aponeurotic vessels by the separation of the immobile fascia under the mobile subcutaneous tissue.…”

“…The blunt trauma or tangential force to the fascia results in tearing of the trans-aponeurotic vessels by the separation of the immobile fascia under the mobile subcutaneous tissue. Thus, a cavity comes into being due to the accumulation of hematomas and lymphocele, including necrotic and damaged skin tissues [1][2][3][4][5][6][7][8][9]. MLL is also referred to as "closed internal degloving injury", "Posttraumatic soft tissue cyst", "Morel-Lavallee extravasation or effusion" and "Chronic expanding hematoma".…”

“…MLL is often the result of traffic accidents, but it can also be seen in people who play sports with close contact, such as football or wrestling [1,2,3,7]. MLL diagnosis is often delayed because clinical findings are variable and subcutaneous tissue injury are masked by skin findings [4,7,8]. It can occur in hours or days or even months or even years after the trauma [1,2,3,6].…”

“…It can occur in hours or days or even months or even years after the trauma [1,2,3,6]. Clinical findings such as swelling, ecchymosis, tension, pain, hypoesthesia in the lesion area and skin deformity can be detected in these cases [2,4]. Diagnosis is based on USG, CT and MR imaging methods besides physical examination findings [2,3,6,7].…”

“…Diagnosis is based on USG, CT and MR imaging methods besides physical examination findings [2,3,6,7]. Treatment of acute or chronic lesions may vary [1][2][3][4]6,8,9]. In this case report, a 55-year-old female who was referred to our department by the court was evaluated.…”