RESUMO
Resumen Introducción: el síndrome de Morel-Lavallée (SML) es una lesión por desgarro en la fascia profunda y el tejido celular subcutáneo causada por cizallamiento. La incidencia del SML ha sido estimada en alrededor de 0.7% en pacientes víctimas de accidente de tránsito. El diagnóstico se realiza mediante la exploración clínica, ecografía y resonancia magnética. El síndrome se ha clasificado en seis tipos imagenológicos de acuerdo a la cronicidad, composición del tejido y aspecto en la resonancia magnética. Estas lesiones tienen una tasa de infección de 46%, que pueden poner en riesgo la vida del paciente, por lo cual requieren manejo oportuno. Métodos: paciente masculino de 20 años quien sufre accidente de tránsito en calidad de ciclista, en donde fue arrastrado por un vehículo de carga generando quemaduras por fricción de primer, segundo y tercer grado en hemicuerpo izquierdo asociado a formación de hematomas en las extremidades inferiores que condicionaron la aparición del SML, a través de la aplicación de escleroterapia, bursectomía y la técnica novedosa de las incisiones en "emparrillado" se logró la resolución de los seromas crónicos. Resultados: después de un juicioso estudio de la historia clínica, las imágenes diagnósticas y el examen físico se logra documentar que se estaba frente al caso de un síndrome de Morel Lavallée el cual es muy raro en la población por lo que hace difícil su diagnóstico, sin embargo, después de un largo tiempo, múltiples intervenciones por el equipo quirúrgico y la instauración de técnicas hibridas en el manejo de esta patología se logró un muy buen resultado tanto funcional como estético. Conclusiones: en este caso se presenta una técnica novedosa en el tratamiento del SML en un centro de salud privado, con aparición inusual en las heridas postraumáticas, que a pesar del manejo temprano pueden progresar a su etapa tardía y generar complicaciones serias. Es importante realizar un diagnóstico temprano y un manejo adecuado para evitar complicaciones graves en pacientes con SML.
Abstract Introduction: Morel-Lavallée syndrome (MLS) is a tearing injury to the deep fascia and subcutaneous cellular tissue caused by shearing. The incidence of MLS has been estimated to be about 0.7% in patients who are victims of traffic accidents. The diagnosis is made by clinical examination, ultrasonography and magnetic resonance imaging. The syndrome has been classified into six imaging types according to chronicity, tissue composition and MRI appearance. These lesions have an infection rate of 46%, which can be life-threatening and therefore require timely management. Methods: 20-year-old male patient who suffers traffic accident as a cyclist, where he was dragged by a cargo vehicle generating friction burns of first, second and third degree in left hemibody associated with hematoma formation in the lower extremities that conditioned the appearance of SML, through the application of sclerotherapy, bursectomy and the novel technique of incisions in "grid" the resolution of chronic seromas was achieved. Results: after a judicious study of the clinical history, diagnostic images and physical examination it was possible to document that it was a case of a Morel Lavallée syndrome which is very rare in the population making its diagnosis difficult, however after a long time, multiple interventions by the surgical team and the establishment of hybrid techniques in the management of this pathology a very good result both functional and aesthetic was achieved. Conclusions: this case presents a novel technique in the treatment of SML in a private health center, with unusual occurrence in post-traumatic wounds, which despite early management can progress to its late stage and generate serious complications. Early diagnosis and proper management are important to avoid serious complications in patients with SML.
RESUMO
Closed degloving injuries are uncommon, high-energy injuries that separate the bony structures from the soft tissue and frequently result in amputation. Because the epidermis is often intact, it is difficult to visualize the extent of the soft tissue damage. Although there is no gold standard of treatment for closed degloving injuries at present, previous cases have reported that neurovascular presentation is a key predictor of amputation Herein, we report a closed degloving injury involving the second through fifth phalanges of the left foot following a crushing injury with a forklift. Despite adequate capillary refill upon initial presentation, the patient ultimately underwent transmetatarsal amputation.
Assuntos
Lesões por Esmagamento , Lesões dos Tecidos Moles , Amputação Cirúrgica , Humanos , Lesões dos Tecidos Moles/diagnóstico por imagem , Lesões dos Tecidos Moles/cirurgia , Dedos do Pé/diagnóstico por imagem , Dedos do Pé/lesões , Dedos do Pé/cirurgiaRESUMO
RESUMEN Se presenta el caso del paciente de 36 años de edad, con antecedentes de acondroplasia que desde hace 7 meses sufrió una lesión traumática no de gravedad en la rodilla derecha. La cual comienza a aumentar de volumen con contenido líquido fluctuante. Fue puncionado en dos ocasiones obteniéndose líquido serohemático; al no resolver y continuar aumentando de tamaño, se le plantea que es portador de un hematoma seroso de Morel Lavallée, que se produce por la fricción entre el tejido celular subcutáneo y la fascia. Su localización es infrecuente en la rodilla por lo que se decide presentar el caso ya que en la literatura revisada; no aparece ningún caso descrito. Por lo que constituye el objetivo principal de este trabajo, describir su proceder y la eficacia del tratamiento quirúrgico, con el que se obtuvo resultado satisfactorio (AU).
ABSTRACT We present the case of a patient aged 36 years, with antecedents of achondroplasia who 7 months ago suffered a non serious traumatic lesion in the right knee. The volume of the lesion began to increase with a fluctuant fluid contain. It was punctured twice draining serohematic fluid; it did not solve and the size increased more and more, so the patient was said that he had a serous Morel Lavallée hematoma, produced by the friction between the subcutaneous cell tissue and fascia. Its location in the knee is infrequent and it was not found any case like this in the reviewed literature; therefore we decided to present the case. The main objective of our work was describing it, showing the procedure and efficacy of the surgical that gave a satisfactory result (AU).
Assuntos
Humanos , Masculino , Adulto , Hematoma/epidemiologia , Joelho/anormalidades , Acondroplasia/diagnóstico , Acondroplasia/patologia , Ferimentos e Lesões/diagnóstico , Fricção/fisiologia , Fáscia/anormalidadesRESUMO
RESUMEN Se presenta el caso del paciente de 36 años de edad, con antecedentes de acondroplasia que desde hace 7 meses sufrió una lesión traumática no de gravedad en la rodilla derecha. La cual comienza a aumentar de volumen con contenido líquido fluctuante. Fue puncionado en dos ocasiones obteniéndose líquido serohemático; al no resolver y continuar aumentando de tamaño, se le plantea que es portador de un hematoma seroso de Morel Lavallée, que se produce por la fricción entre el tejido celular subcutáneo y la fascia. Su localización es infrecuente en la rodilla por lo que se decide presentar el caso ya que en la literatura revisada; no aparece ningún caso descrito. Por lo que constituye el objetivo principal de este trabajo, describir su proceder y la eficacia del tratamiento quirúrgico, con el que se obtuvo resultado satisfactorio (AU).
ABSTRACT We present the case of a patient aged 36 years, with antecedents of achondroplasia who 7 months ago suffered a non serious traumatic lesion in the right knee. The volume of the lesion began to increase with a fluctuant fluid contain. It was punctured twice draining serohematic fluid; it did not solve and the size increased more and more, so the patient was said that he had a serous Morel Lavallée hematoma, produced by the friction between the subcutaneous cell tissue and fascia. Its location in the knee is infrequent and it was not found any case like this in the reviewed literature; therefore we decided to present the case. The main objective of our work was describing it, showing the procedure and efficacy of the surgical that gave a satisfactory result (AU).
Assuntos
Humanos , Masculino , Adulto , Hematoma/epidemiologia , Joelho/anormalidades , Acondroplasia/diagnóstico , Acondroplasia/patologia , Ferimentos e Lesões/diagnóstico , Fricção/fisiologia , Fáscia/anormalidadesRESUMO
Traumatic degloving injuries of the lower extremity are commonly diagnosed by soft tissue deficits and separation of soft tissue planes. The management of open degloving injuries is well documented with established treatment protocols. Because closed degloving injuries of the lower extremity are so rare, the protocol management is not well established. Unlike open degloving injuries, evidence of soft tissue injury and detachment of the tissue planes can be subtle. Owing to the rarity of these injuries, little has been described regarding the long-term outcomes. In the present report, 2 closed degloving cases are presented. The first case presented is of a 27-year-old railroad worker who sustained a severe closed degloving injury of his foot with digital soft tissue envelope transposition. The second case involved a 60-year-old automobile manufacturer, whose foot was crushed by a hydraulic fork lift, creating a degloving injury of the third, fourth, and fifth toes. The follow-up duration from the date of injury for patient 1 was 26 months and for patients 2 was 16 months. The purpose of presenting these cases is to report these rare injuries with the treatment, complications, and outcomes.
Assuntos
Amputação Cirúrgica/métodos , Lesões por Esmagamento/cirurgia , Avulsões Cutâneas/cirurgia , Traumatismos do Pé/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Adulto , Lesões por Esmagamento/diagnóstico por imagem , Avulsões Cutâneas/diagnóstico por imagem , Seguimentos , Traumatismos do Pé/diagnóstico por imagem , Fixação Interna de Fraturas/métodos , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Radiografia/métodos , Reoperação/métodos , Medição de Risco , Estudos de Amostragem , Dedos do Pé/diagnóstico por imagem , Dedos do Pé/lesões , Resultado do Tratamento , Cicatrização/fisiologiaRESUMO
Se presenta el caso de un paciente adulto de 58 años de edad que acudió a consulta por una masa de crecimiento lento y progresivo en la cadera izquierda adyacente al trocánter mayor del fémur, de dos años de evolución, la cual apareció como consecuencia de un trauma directo en un accidente automovilístico. Los hallazgos fueron sugestivos del síndrome de Morel-Lavallée. Este síndrome fue descrito a mediados del siglo XIX, y si bien es conocido por los médicos traumatólogos, rara vez se menciona en la literatura médica. Corresponde a la formación de una colección hemolinfática localizada entre la hipodermis y la fascia aponeurótica, secundaria a traumatismos. El diagnóstico es clínico, complementado con exámenes radiológicos. El tratamiento de este síndrome aún es controvertido.
We report the case of a 58 year old patient who consulted due to a mass with low and progressive growth in the left hip, adjacent to the greater trochanter of the femur, with an evolution of two years. This growth appeared as a consequence of a direct trauma in an auto accident. The findings were suggestive of Morel- Lavallée syndrome. Morel-Lavallée syndrome was described in the mid- nineteenth century. Although it is known to orthopedists, it is rarely mentioned in literature. It corresponds to the formation of a hemolymphatic collection located between the hypodermis and the aponeurosys, secondary to traumas. The diagnosis is based on clinical grounds, supplemented by radiological examinations. The treatment of this syndrome is still controversial.