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The Morel-Lavallée lesion is an uncommon closed degloving injury that most often occurs in the setting of high-energy trauma and can be associated with other traumatic injuries, including fractures of the pelvis, acetabulum, or femur. The superficial soft tissues are forcibly separated from the underlying deep fascia, resulting in damage to penetrating blood vessels and lymphatics. A fluid collection consisting of lymph, blood, and/or necrotic tissue subsequently develops and is most common in the region of the greater trochanter. Awareness of this entity is important to prevent a delay in diagnosis and decrease the risk of potential complications such as pseudocyst formation, pressure necrosis of the overlying skin, chronic pain, and infection. We present the case of a 49-year-old man who noticed a fluid collection in his right lateral upper thigh 1 week after slipping and falling down half a flight of stairs. Ultrasound demonstrated a fusiform fluid collection between the subcutaneous fat and underlying deep fascia, consistent with a Morel-Lavallée lesion. After reviewing various treatment options, the patient elected to undergo nonsurgical management. The lesion persisted but substantially improved 6 weeks after the initial injury. This case underscores the need to consider Morel-Lavallée lesions in the appropriate clinical context.

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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.

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The Morel-Lavallée lesion is an internal degloving injury seen after a traumatic force. These lesions are frequently missed on initial presentation, leading to a delay in diagnosis and increased morbidity. We present a case of a 52-year-old male who suffered an injury to his right thigh and was ultimately diagnosed with a Morel-Lavallée lesion after the third emergency department visit. Point-of-care ultrasound (POCUS) assisted with making the diagnosis and expediting proper care.

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Morel-Lavallee lesions are uncommon injuries and there is a lack of data to support what the most effective management is. In the case of a young athlete with a small lesion, we propose that conservative treatment with rest and close follow up is appropriate.

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Introduction: Morel-Lavallée lesion (MLL) is a closed degloving injury that occurs after traumatic damage to soft tissue, leading to the formation of an encapsulated serosanguinous collection of fluid. Although some MLLs resolve spontaneously, chronic MLLs present with a significant risk of infection and may impede patients' quality of life. Chronic lesions require surgical intervention to evacuate and debride the hematoma, often resulting in severe cosmetic damage postoperatively. Case Report: We documented a large 19.4 cm × 4.2 cm × 15.10 cm MLL on the right lateral hip that presented a significant impediment to the patient's daily functions. After the failure of conservative management, the patient was treated surgically through a minimal incision debridement procedure, utilizing a wound drain and vacuum-assisted compressional dressing upon closure. Excellent 1-year post-operative outcomes were achieved with no recurrence of the lesion and limited cosmetic evidence of the MLL. Conclusion: This case highlights the value of a limited incisional debridement procedure for the management of a chronic Morel-Lavellée lesion. When using this technique, surgeons can effectively treat these lesions with promising short-term outcomes and minimal wound scarring.

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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.

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We report a chronic Morel-Lavallée lesion around the knee in a competitive high schooler softball player, successfully treated with video-assisted endoscopic debridement. Endoscopic surgery is a viable option to treat Morel-Lavallée lesions in active patients who seek a rapid return to sport. The potential advantages of an endoscopic treatment would be a faster healing process and an earlier return to motion and function due to a less morbid and more cosmetic surgical approach.

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The presentation of a Morel-Lavallée lesion in the lumbosacral region following a road traffic accident is an uncommon clinical entity. Knowledge of this rare site of occurrence can help in early diagnosis and proper management.

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Morel-Lavallée lesions are uncommon soft tissue injuries resulting from trauma, characterized by the separation of subcutaneous tissue from the underlying fascia. Soft tissue infections with Pseudomonas aeruginosa are rare and most typically associated with hospital-acquired infections and burn wounds. This case report is regarding a 57-year-old man following a motorcycle accident who presented with a unique occurrence of an MLL complicated by P. aeruginosa infection. The patient underwent extensive treatment over the course of months, which may have been prevented with a better understanding of the injury. This case is noteworthy due to the infrequency of the injury, the pathogen, and concomitant occurrence, presenting a diagnostic and therapeutic challenge. We describe the patient's clinical presentation, hospital course, diagnostic workup, and management to inform future care and recognition of similar patients.

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A Morel-Lavallee lesion (MLL) is a rare internal denudement injury of skin and hypodermis from deep fascia, usually occurring hours to days after an inciting trauma. A common location is the pelvis or thigh where there is prominent vascularization and may mimic diagnoses such as deep vein thrombosis or contusion. Fluid collections that persist despite conservative management require surgical intervention and frequent and prolonged hospitalizations as in this case of a patient with a persistent MLL. We emphasize early imaging for diagnosis and surgical service involvement, as delay may lead to persistent symptoms and worse health outcomes.

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We report the case of a 41-year-old man with a Morel-Lavallée lesion (MLL) that developed an infection. The patient was initially treated with intravenous antibiotics, but the infection persisted. He was then treated with outpatient cleansing and retention sutures, which resulted in successful wound healing. This case report demonstrates the efficacy of outpatient cleansing and retention sutures for the treatment of MLL infection. This treatment modality is less expensive than inpatient treatment, and it allows the patient to return to their normal activities sooner.

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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.

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A 14-year-old male presented to the sports medicine clinic for evaluation of right lateral knee pain for three weeks after he took a forceful blow to his right lateral knee during a football game. He reported swelling and bruising and increasing pain since then. Physical exam was significant for an area of fluctuance that was approximately 20 cm in length and 10 cm in width overlying the lateral right knee with associated ecchymosis and decreased sensation. The remainder of the exam was benign. Point-of-care ultrasound showed a large hypoechoic space overlying the lateral knee consistent with a Morel-Lavallée lesion (MLL). Twenty-six milliliters of serosanguinous fluid were aspirated from between the fascial planes, deep to subcutaneous fat but superficial to quadriceps muscles, under ultrasound guidance. The lesion was sclerosed with 1 cc 1% lidocaine without epinephrine and 4 cc dexamethasone 4 mg/mL, and the patient was given compression wrappings to wear for the next four weeks. MLLs are collections of fluid that occur between different planes of subcutaneous tissue following blunt force or shearing trauma. The general mechanism of injury is a closed degloving injury that occurs following damage to the potential space between layers of fascia, dermis, and subcutaneous fat. MLLs are relatively rare lesions and, when identified, are most frequently found in the proximal thigh and associated with serious underlying bony fractures. MLLs are uncommon and difficult to diagnose due to their nonspecific findings of fluctuance, pain, and bruising. This case is unique in its presentation of an isolated MLL in the lateral knee. Early diagnosis and intervention of these lesions prevent further sequelae.

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Case: An 81 year old male with four failed aspirations presented with recurrent knee swelling following irrigation and debridement, which suggested the presence of a Morel-Lavallée lesion (MLL). This diagnosis was intraoperatively confirmed by separation of the tissue layers forming a space with accumulated fluid. Treatment consisted of doxycycline sclerodesis and tight closure of the tissue layers. The patient had a satisfactory outcome at 4 months. Conclusion: Resolution of Morel-Lavallée lesions requires prompt recognition and appropriate treatment. In the presence of a different diagnosis, recurrence of symptoms following treatment may indicate an MLL. Surgical treatment with doxycycline sclerodesis resulted in resolution of symptoms.

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OBJECTIVES: Here we describe a rare post-traumatic lesion and discuss its management. BACKGROUND: Lumbar Morel-Lavallée is a rarely reported lesion. The cause is usually post-traumatic in a polytraumatic context, and care is often focused elsewhere. This leads to misdiagnosis with a risk of chronic pain and infection. In addition, there is no consensus for the management as few cases have been reported so far. CASE REPORT: A 35-year-old African woman was involved in a motor accident. Physical examination at the emergency department revealed moderate head trauma, a lumbar inflammatory mass, and a closed leg fracture. She underwent a whole-body computed tomography scan, which revealed a left frontal brain contusion and a large left paraspinal mass in favor of a lumbar Morel-Lavallée lesion. She benefited from osteosynthesis and conservative management of the cerebral and lumbar lesions. After 4 days, she complained of headaches and vomiting. Magnetic resonance imaging was requested. There was resorption of the cerebral contusion, and the lumbar mass was heterogeneous. She was discharged 10 days later without lower back pain and fully recovered from the headaches. Ultrasound of the lumbar soft tissue performed a month later showed no more collection. CONCLUSION: More frequent in young men, lumbar Morel-Lavallée lesion is underdiagnosed. Thus, there is no consensus on its treatment. However, conservative management followed by close monitoring is advisable in the acute phase. Other therapy includes surgery with or without the use of sclerosing agents. Early diagnosis prevents infections. Although the diagnosis is clinical, magnetic resonance imaging is the critical paraclinical examination for its assessment. Our case is interesting because it occurs in a woman following polytrauma, and to the best of our knowledge, it is an extremely rare lesion, especially in women.

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A 22-year-old female patient was seen in the emergency department with a two-week onset of progressively worsening pain and swelling to the medial aspect of her distal left femur. The patient was involved in an automobile versus pedestrian accident two months prior sustaining superficial swelling, tenderness, and bruising to the affected area. Radiographs revealed soft tissue swelling without osseous abnormalities. Examination of the distal femur region revealed a large, tender, ovoid area of fluctuance with a dark crusted lesion and surrounding erythema. Bedside ultrasonography revealed a large anechoic fluid collection in the deep subcutaneous plane with mobile internal echogenic debris which was suspicious for a Morel-Lavallee lesion. The patient underwent contrast enhanced CT of the affected lower extremity demonstrating a 8.7 cm x 4.1 cm x 11.1 cm fluid collection superficial to the deep fascia of the distal posteromedial left femur, confirming the diagnosis of a Morel-Lavallee lesion. A Morel-Lavallee lesion is a rare, post-traumatic degloving injury that results in the separation of the skin and subcutaneous tissues from the underlying fascial plane. The resultant disruption of the lymphatic vessels and underlying vasculature leads to progressively worsening hemolymph accumulation. If not recognized and treated in the acute or subacute period, complications can ensue. Complications of Morel-Lavallee include recurrence, infection, skin necrosis, neurovascular injury, as well as chronic pain. Treatment is based on the size of the lesion and ranges from conservative management and surveillance for small lesions to percutaneous drainage as well as debridement, sclerosing agents, and surgical fascial fenestration approaches for larger lesions. Additionally, the utilization of point-of-care ultrasonography can help in the early identification of this disease process. This is important as a delay in diagnosis and subsequent treatment of this disease state is associated with long-term complications.

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BACKGROUND: Morel-Lavallée lesions, also known as an internal degloving injuries, occur hours to months after high-speed shearing trauma, usually in the peri-trochanteric region. These are uncommon injuries, and are often missed as part of the trauma examination. Failure to diagnose or treat these lesions may result in complications, such as infected seromas, chronic cosmetic deformities, capsule formation, or skin necrosis. There are no formalized societal guidelines for management, but smaller studies have recommended compression alone for asymptomatic lesions, aspiration for small symptomatic lesions, and open debridement for large lesions. CASE REPORT: A young woman presented with swelling, fluctuance, and paresthesia to her right hip after falling off her bicycle 1 week earlier. Physical examination showed a fluctuant and hypoesthetic area over the greater trochanter and point-of-care ultrasound showed a hypoechoic and compressible fluid collection between a fascial layer and a subcutaneous layer, confirming the diagnosis of a Morel-Lavallée lesion (internal degloving injury). Symptoms did not improve with compression alone, but did improve after fluid aspiration. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Morel-Lavallée lesions are frequently missed traumatic injuries. Morel-Lavallée lesions can be diagnosed quickly and cost-effectively in the emergency department through the combination of a thorough history, physical examination, and bedside ultrasound. Although there are no formal societal guidelines, limited studies suggest management strategies, including compression, aspiration, and open debridement, with treatments varying by symptom severity and lesion size.

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BACKGROUND: Trauma patients present to the emergency department with various injuries. Few injuries can be easily missed during the evaluation of polytrauma patients. We report one such rare injury in a trauma patient. CASE REPORT: We report the case of a 67-year-old man who presented to the emergency department with an alleged history of trauma. He reported severe pain in the lower abdomen, right hip, and right thigh. An x-ray study did not reveal any bony injury, and an extended focused assessment with sonography in trauma was also negative. Point-of-care ultrasound of his right thigh revealed the presence of a Morel-Lavallée lesion. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Morel-Lavallée lesions are post-traumatic, closed, degloving injuries that go unnoticed in many polytrauma patients. Emergency physicians should be mindful of this lesion because delay in diagnosis can result in significant complications.

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