Morel-Lavallée Lesion: A Closed De-Gloving Injury
INTRODUCTION: Morel-Lavallée lesions (MLLs) are uncommon closed, degloving injuries secondary to blunt or shear trauma causing deep investing fascia to separate from underlying musculature creating a pathological space. Disruption of vessels and accumulation of fluid within the space causes necrosis of surrounding tissue. One-third of MLLs are missed at acute presentation, likely due to unfamiliarity. Untreated MLLs may become infected or progress to a capsule, which complicates management. MLLs are most often seen with orthopedic trauma. Hip injuries account for 30.4% of cases, rare leg lesions account for only 1.5% of cases.
CASE REPORT: A 66-year-old male presented to emergency department with shearing trauma to the anterolateral leg, tenderness, erythema, ecchymosis, swelling and skin avulsion. X-ray and ultrasound ruled out fracture and deep vein thrombosis, respectively. Cellulitis was diagnosed presumptively and treated with oral antibiotics. The non-healing lesion prompted wound care consultation with a working diagnosis of refractory cellulitis. The patient was subsequently found to have an area of necrotic tissue and hematoma superficial to the deep fascia. Irrigation and debridement followed by post-operative wound care provided definitive resolution.
DISCUSSION: MLLs should be considered in patients with a history of shearing trauma followed by focal pain, swelling, and ecchymosis. For this case of a non-healing lesion, fluctuant mass, and necrosis of surrounding tissue, the pathology is consistent with an MLL. MLL is a clinical diagnosis; however, MLLs are best visualized with MRI. Management can be conservative (ex. compression bands), but severe cases may require surgical intervention.