Best Practice Case Studies-Case 121 Asset 3 The Morel-Lavallee Lesion: Review and Update

Pdf Summary

This review summarizes the Morel-Lavallée lesion, a closed soft-tissue degloving injury caused by shear forces that separate skin/subcutaneous tissue from deep fascia, creating a cavity filled with blood, lymph, and fat. It most often occurs after high-energy trauma and is commonly seen in the thigh, hip, pelvis, and greater trochanter region, often alongside pelvic, acetabular, or proximal femur fractures. Because it is frequently missed or diagnosed late, it may increase the risk of skin necrosis, infection, and complications during fracture surgery.<br /><br />Clinically, the lesion may appear within hours to days after injury, but some cases present months or years later. Acute lesions often show pain, swelling, ecchymosis, fluctuance, skin hypermobility, reduced sensation, or even shock in severe bleeding. Chronic lesions may present as a persistent cystic mass or seroma-like swelling.<br /><br />MRI is the best imaging modality because it defines lesion size, contents, chronicity, and capsule formation. Ultrasound can support diagnosis, especially by showing a compressible fluid collection, while CT mainly confirms fluid and is less specific.<br /><br />Treatment depends on lesion size, stage, location, recurrence risk, infection, and whether nearby fracture surgery is planned. Small acute lesions without a capsule may respond to compression. Percutaneous aspiration can help with small collections but has a high recurrence rate, especially in larger lesions. Sclerodesis with agents such as doxycycline, talc, ethanol, or tetracycline is effective for persistent lesions. Minimally invasive approaches—such as drainage, quilting sutures, fibrin sealant, liposuction-assisted techniques, and endoscopic debridement—aim to eliminate dead space and reduce recurrence. Large, chronic, infected, or skin-compromising lesions may require open debridement, sometimes with negative pressure wound therapy, grafts, or flaps.<br /><br />Overall, early recognition and appropriate management are essential to prevent recurrence, infection, and surgical complications.

Meta Tag

Edition 4th Edition

Related Case 4th Edition, Case 121

Topic Dermatology

Keywords

Morel-Lavallée lesion

closed degloving injury

shear trauma

soft tissue injury

MRI diagnosis

pelvic fracture

thigh hematoma

sclerodesis treatment

percutaneous aspiration

open debridement

4th Edition

4th Edition, Case 121

Dermatology