Morel-Lavallee lesion in distal thigh: A case report

Abstract

Close degloving injury Distal thigh ACL a b s t r a c tIt is a relatively rare condition involving a close degloving injury due to direct trauma with tangential force followed by the separation of the subcutaneous tissue from the underlying fascia. The rupture of small perforating vessels in this area, resulting in the formation of a cavity that filled with blood, lymph and fat foci, the latter being sometimes necrotic. MorelLavallee lesion was originally described in the lateral aspect of the proximal thigh, which is the most common site of this lesion; however other anatomic sites such as periscapular, lumbar and gluteal regions, ankles and knees have been described in the literature. Various methods of treatment has been described, but open debridement can result in a successful functional outcome.Copyright © 2014, Delhi Orthopaedic Association. All rights reserved. IntroductionMorel-Lavallee lesion is a common but rarely described posttraumatic closed soft tissue injury sequel. 1 MLL in distal thigh is a relatively rare condition involving a close degloving injury due to direct trauma with tangential force followed by the separation of the subcutaneous tissue from the underlying fascia. Because of it, the rupture of small perforating vessels in this area, resulting in the formation of a cavity filled with blood, lymph and fat foci, the latter being sometimes necrotic. 2,3 Morel-Lavallee lesion was originally described in the lateral aspect of the proximal thigh, which is the most common site of this lesion; however other anatomic sites such as periscapular, lumbar and gluteal regions, ankles and knees have been described in the literature. 4,5 The case is reported to us with swelling over the anteromedial aspect of distal left thigh with ipsilateral united fracture of medial tibial condyle and partial ACL tear. This type of combination of injuries has not been described previously. Surgical intervention in the form of open debridement was done and resulting in the dramatic improvement. Case reportA 45 years old male presented with swelling over anteromedial aspect of distal left thigh (Fig. 1A þ B). He complained pain left knee during walking and also, weakness left lower limb following trauma. He met with an accident one and half year back, while driving a motorcycle and he was hit by a car from back. He sustained fracture left clavicle, ipsilateral medial tibial condyle and bruises over the anterior aspect of left distal thigh managed conservatively. On follow-up of after one month POP slab was removed and found huge swelling

Morel-Lavallée in Collegiate Wrestler

“…Morel-Lavallée Lesions are a result of posttraumatic shearing of the subcutaneous tissue away from the underlying fascia (Kumar, 2014). The rupture of small perforating vessels in the area creates a cavity, which can fill with blood, lymph, and necrotic fat (Kumar, 2014). Morel-Lavallée Lesions are a very unique pathology and in many cases goes misdiagnosed.…”

Large Morel-Lavallée lesion presenting as fungating mass with skin ulceration

“…[2][3][4] Recent case reports of Morel-Lavallé e lesions involving the distal thigh, pre-patellar region, and pelvis have described lesions mainly presenting with swelling or evidence of ecchymosis. [5][6][7] The patient described here presented with a large fungating mass and overlying skin ulceration. At first, this lesion was highly suspicious for sarcoma.…”

Morel-Lavallée lesion in a ‘non-traumatic’ thigh: a diagnostic challenge!

“…MLS was first described in 1863 by the French surgeon Victor Auguste Francois Morel-Lavallée as fluid collections dissecting fatty tissues 1 .This term has now expanded to encompass any closed degloving injury causing persistent fluid collection. Though these lesions can occur anywhere, they are particularly common in the proximal thigh and in the trochanteric region 2 .Though MLS are most common after violent tangential trauma such as road traffic accidents (RTA), usually in association with pelvic/ acetabular fractures, they have also been reported after surgical procedures such as abdominoplasty and in a few cases, the patient does not recall the occurrence of trauma, as in our case 3 .The shearing forces due to trauma cause the mobile skin and subcutaneous tissue to avulse from the relatively fixed aponeurotic fascia. This causes injury to blood vessels and/or lymphatics causing accumulation of fluid in the potential space formed.…”

“…This causes injury to blood vessels and/or lymphatics causing accumulation of fluid in the potential space formed. The hematoma/ seroma thus formed can later encapsulate 2,4 . A gradually growing swelling of thigh can lead to a diagnostic dilemma.…”

“…Progression of inflammatory reaction results in the formation of a pseudocapsule comprising of predominantly fibrous tissue. This encapsulation is responsible for the persistent nature of this condition, making treatment long and difficult [1][2][3][4] . MLL most often presents within hours to days posttrauma, seen unilaterally and commonly coexisting with underlying fractures.…”