Morel-Lavallée Lesion Following a Low-speed Injury: A Case Report

Abstract

Introduction: Soft tissue injuries are a common presenting complaint seen in the emergency department following trauma. However, internal degloving injuries are not commonly seen by the emergency provider. Case Report: A 57-year-old male presented with right lower extremity pain, bruising, and swelling after a low-speed bicycle accident five days prior. Physical examination revealed an edematous and ecchymotic right lower extremity extending from the mid-thigh distally. Computed tomography of the thigh demonstrated a hyperdense foci within the fluid collection suggesting internal hemorrhage and internal de-gloving suggestive of a Morel-Lavallée lesion. Discussion: The Morel-Lavallée lesion is a post-traumatic soft tissue injury that occurs as a result of shearing forces that create a potential space for the collection of blood, lymph, and fat. First described in 1853 by French physician Maurice Morel-Lavallée, this internal degloving injury can serve as a nidus of infection if not treated appropriately. Magnetic resonance imaging has become the diagnostic modality of choice due to its high resolution of soft tissue injuries. Treatment has been focused on either conservative management or surgical debridement after consultation with a surgeon. Conclusion: The emergency physician should consider Morel-Lavallée lesions in patients with a traumatic hematoma formation to avoid complications that come from delayed diagnosis.

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

“…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.…”

“…12 The studies included in this review concluded that MRI is the diagnostic imaging modality of choice in the assessment of ML lesions, due to its high contrast resolution, multiplanar image acquisition and enhanced anatomic details. 10,26 The magnetic properties of blood breakdown products are an essential factor that determine the MRI appearance of ML lesions. The acute ML lesion (Figure 3) appears hypointense on T1-weighted (T1-WI) images and hyperintense on T2-weighted (T2-WI) images due to presence of blood within the lesion.…”

Management and Novel Treatment of Degloving Soft Tissue Injuries: A Case Report

“…DSTIs may encompass a wide variety of traumatic forces, each presenting with a relatively unique challenge in terms of tissue damage and subsequent management. High-energy traumas, usually stemming from MVAs and industrial accidents, can subject the body to extremely high-impact forces, resulting in DSTIs that may span large body regions and may have additional fractures or internal injuries [3]. Crush injuries, also seen in industrial accidents, or falls, generate forces that separate skin and soft tissue from underlying structures [1].…”