Morel-Lavallee lesions. Size matters? Treatment and time of disability

Morel-Lavallee associated lymphedema treated with lymphovenous anastomosis: A case report

Morel-Lavallee Lesions lead to disruption of lymphatic anatomy that require early identification and may necessitate lymphatic reconstruction. We present the case of a 59-year-old male with lower extremity lymphedema resulting after a severe Morel-Lavallee lesion and treated using lymphovenous anastomoses. He was initially managed with multiple aspirations followed by repeat incision and drainage. At 10 months following his injury, he continued to have swelling of his upper thigh and developed a large festoon medially, with lower leg pitting edema. He was diagnosed with lymphedema via lymphoscintigraphy. His superficial lymphatic anatomy was visualized using indocyanine green (ICG) lymphography and showed diffuse dermal backflow across his thigh, with signs of altered lymphatic anatomy distally. We preformed two lymphovenous anastomoses at the level of his mid-thigh to bypass the lymphatic disruption and restore drainage to his lower leg. After rerouting lymphatic flow from the lower extremity, the patient had overall improvement of his symptoms and reduced swelling with continued therapy. At 5 months postoperatively, his volumetric lower extremity measurements showed a decrease by 314 mL and he began walking again in 20-minute intervals. Lymphedema may be an important consideration following severe Morel-Lavallee lesions. Using modern diagnostic and supermicrosurgical techniques, plastic surgeons can help treat this long-term morbidity.

Mid-term prognosis of endoscopic debridement combined with percutaneous cutaneo-fascial suture for the treatment of Morel-Lavallée lesion: a minimum 3-year follow-up study

PURPOSE

Morel-Lavallée lesion (MLL) is a closed soft-tissue degloving injurie resulting from shear forces. With the advent of endoscopic technology and advancements in surgical techniques, innovative solutions are now available. However, there are few data on mid-term results after treatment of MLL, especially regarding arthroscopic method. The objective of this study is to evaluate the clinical outcomes of endoscopic debridement combined with percutaneous cutaneo-fascial suture in treating MLL.

METHODS

A single-center retrospective study was conducted at a university teaching hospital investigating patients who underwent arthroscopic management of Morel-Lavallée lesion between 2014 and 2020.Patient demographics, postoperative recovery time, peri- and postoperative complications were investigated. Mid-term follow up clinical and radiological examinations were performed.

RESULTS

The retrospective study included 38 patients aged between 11 and 90 years, with an average age of 50.9 ± 16.9 years. These patients waited an average of 36.6±23.5days to return to work after operation. The average time to follow-up was from 3 to 9 years, averaging 5.0 ± 1.8 years. At the end of follow-up, only one complication of superficial skin necrosis occurred, accounting for 2.6%. The imaging assessment at the final follow-up indicated improvement over the postoperative period for all 38patients.

CONCLUSION

In mid-term experience, endoscopic debridement combined with percutaneous cutaneo-fascial suture for MLL management is a safe and effective option.

The treatment of a Morel-Lavallée lesion of the thigh with incision and drainage along with tissue debridement and a surgically placed drain: A case report and literature review

Background

A Morel-Lavallée lesion (MLL) is a rare closed degloving injury that usually occurs around the hips and is associated with pelvic fractures after high-energy trauma, which is commonly overshadowed by other severe post-traumatic manifestations. An isolated MLL, mostly caused by low-energy violence, is even rarer. Thus, the rates of misdiagnosis and missed diagnosis are often high. In this case report and literature review, we review the pathophysiology, clinical manifestations, imaging data, and treatment of this lesion to increase awareness of this rare disease.

Case report

We report the case of an isolated MLL in the right thigh caused by trauma, which happened to be one of missed diagnosis both at the initial visit and at the return visit of the patient, with a significant sign of a mass on MRI. Given the size of the lesion, open debridement and irrigation were adopted to treat the lesion, and the patient recovered well post-operatively.

Conclusion

Young surgeons should pay attention to the MLL with sufficient recognization to avoid missed diagnosis and misdiagnosis. Comprehensive physical examination and imaging data play important roles in the diagnosis of MLL. In the early stages of this injury, a detailed history review combined with physical examination and MRI, can reduce the rates of missed diagnosis and misdiagnosis. The choice of the therapeutic scheme depends on the size and severity of the lesion. For an isolated MLL, compared with conservative treatments, we suggest that incision and drainage, along with tissue debridement and a surgically placed drain, will reduce the rates of infection and recurrence.