Conservative treatment of a chronic Morel-Lavallée lesion: a case report

Abstract

AIM: The Morel-Lavallee lesion was first described by a French physician in 1863. These lesions are post-traumatic closed soft-tissue degloving injuries characterized by separation of the subcutaneous fat from the underlying fascia induced by violent shear stress. Morel-Lavallee lesions are commonly associated with high-energy trauma and predominantly seen in women. The aim of this case report is to increase awareness to these relatively rare but potentially dangerous and frequently missed post-traumatic lesions. CASE PRESENTATION: A 51-year old woman was repatriated to the emergency department one week after a high-energy traffic accident abroad. Approximately one-month post trauma, during hospitalization on our traumatology department, the patient complained of local pain on the lateral side of the right distal thigh. Clinical evaluation showed a tumor on the distal thigh characterized by a fluctuant mass during palpation. Ultrasound examination described a Morel-Lavallee lesion of circa 9.2x7.5cm. Since the pain only appeared during exercise, a conservative treatment by occasionally bandaging, watchful waiting and careful monitoring were initiated. The symptoms slowly improved and conservative treatment was maintained. CONCLUSION: Morel-Lavallee lesions are post-traumatic closed soft-tissue degloving injuries that are often missed to diagnose. These lesions can be complicated by skin necrosis and infection. There are currently no evidence-based guidelines in the medical literature on the treatment of Morel-Lavallee lesions. Overall, we agree that Morel-Lavallee lesions need close monitoring and evaluation until final healing occurs. Early recognition and optimal management can save patients from undesirable complications and need for complex open surgical treatment.