Arthroscopic treatment for Morel-Lavallée lesion of the thigh: A case report and literature review

Post-operative osteopathic manipulative treatment of Morel-Lavallee syndrome assessed using infrared thermal imaging: A case report

INTRODUCTION

The Morel-Lavallee lesion (MLL) is a closed, degloving soft-tissue injury, wherein the skin and subcutaneous tissue are separated from the underlying fascia. This syndrome causes disruption of wound healing. Infrared thermography is a noninvasive and pain-free tool that can be used to evaluate scar and the influence of osteopathic manipulative treatment.

OBJECTIVE

To evaluate the influence of post-operative osteopathic manipulative treatment (OMT) of Morel-Lavallee lesions (MLL).

METHODS

During four osteopathic sessions on one volunteer patient, 28-year-old male, resulting in MLL of the left knee after motorcycle accident. The effects of OMT were assessed using an infrared thermal imaging camera and qualitative palpation examination of osteopathic dysfunction, scored on a scale of 1-4.

RESULTS

and discussion: Both scar and peri-scar area temperatures increased after OMT. The difference in temperature between the scar and the peri-scar area decreased after OMT. Increase in temperature was greater when the OMT was applied around the scar than when applied at a distance from the scar site. The palpation score for dysfunction of the MLL scar site decreased from 4/4 to 2/4 after the final session.

CONCLUSION

Several OMT sessions focusing on the MLL scar site appear necessary to obtain noteworthy results. OMT improved mobility and increased the temperature of the scar and the peri-scar area.

Morel-Lavallee Lesion Associated With Rhabdomyolysis in Polytrauma

We describe the case of a 30-year-old man who allegedly had a history of road traffic accidents. While walking on the road, he was hit by a truck. He presented with complaints of facial injuries and being unable to move his right lower limb. On examination, there is a 15x4 cm lacerated wound in the perineal area, with left testes exposed; anal tone could not be assessed; the right lower limb is externally rotated; and deformity is present with palpable peripheral pulses. He was diagnosed with a right sacral ala fracture, a distal one-third shaft of the right tibia fracture, and a right suprapubic rami fracture. Ultrasound of the right thigh showed hematoma and subcutaneous edema all around the gluteal and inguinal regions and fluid collection in the right inguinal region, which is suggestive of Morel-Lavallee lesion (MLL) type 6. On day two of admission, urine was dark in color, and creatinine kinase was elevated, which is suggestive of rhabdomyolysis. He was managed with hydration, electrolyte correction for rhabdomyolysis, and wound debridement for MLL apart from perineal injury, right sacral ala fracture, right suprapubic rami fracture, and distal one-third shaft of the right tibia fracture, with perineal repair and loop colostomy, pelvic binder, and external fixator, respectively. Early identification of the MLL associated with rhabdomyolysis in this polytrauma patient led to recovery and a successful outcome.

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

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.

A Physical Therapy Rehabilitative Approach in Improving Activities of Daily Living in a Patient With Morel-Lavallée Syndrome: A Case Report

A limited soft tissue injury known as Morel-Lavallée syndrome is brought on by the violent segregation of the dermis and subcutaneous tissue layer. Shear injury causes perforating arteries and lymphatics to burst, potentially releasing serosanguinous fluid, blood, and necrotic fat into the area. Morel-Lavallée lesions (MLL) can be accompanied by pelvic or acetabular fractures or by blunt trauma without a fracture. MLL is distinguished by enlargement, tightness, and tenderness of tissue. The skin around the lesion is frequently associated with diminished sensory perception. Plain radiography, USG, CT scan, and MRI are some of the imaging modalities that can be utilized. MLLs have a distinct location in the US, anterior to the muscle layer and posterior to the hypodermis. Morel-Lavallée lesions are frequently associated with complications as a result of delayed or inappropriate diagnosis. Surgical drainage and debridement are the standard surgical treatments for the lesion. Physiotherapy rehabilitation helps in reducing pain and regaining functional activities after the syndrome. This documentation includes the case of a 55-year-old male patient who had complaints of difficulty in moving their left leg and inability to walk. The patient was diagnosed with Morel-Lavallée syndrome left thigh and was advised physiotherapy. This study found that by employing strengthening exercises and other physical therapy interventions, after four weeks of therapy, joint degree of movement, muscular strength, and daily functioning, as well as cardiovascular and pulmonary capabilities all significantly improved.

Practical Review of the Comprehensive Management of Morel-Lavallée Lesions

Morel-Lavallée lesions have been described in the literature since the mid-19th century, yet contemporary clinical management continues to be challenging and remains variable. These closed degloving injuries are usually seen in the setting of blunt trauma and are due to shearing forces, creating a space for the collection of hemolymphatic fluid. These fluid collections can be persistent despite conservative treatment attempts and can require staged surgical interventions.