Novel Use of a Closed Liposuction System: Treatment of an Acute Morel-Lavallée Lesion of the Upper Extremity.

Anooj Patel,Anand Kumar,Donald Harvey,Corinne Wee,Mitchell K Ng

doi:10.7759/cureus.8437

Abstract

Morel-Lavallée lesions (MLL) are closed post-traumatic soft tissue shear injuries that occur between fascial planes and may result in tissue loss. Current treatment options for MLL include percutaneous drainage and open irrigation and debridement. A few cases of suction-assisted lipectomy (SAL) have been described for subacute and chronic MLL of the lower extremity. We present the first case report of using a closed SAL system to treat an acute MLL of the upper extremity. A 78-year-old female with right forearm MLL presented after blunt force trauma while on apixaban. After inpatient monitoring and anticoagulant drug clearance, a closed system SAL was performed to evacuate the hematoma and prevent ischemia of overlying soft tissues. Treatment outcomes were measured by clinical exam and CT imaging. Pre-operative diagnostic CT scan demonstrated a 4.8 x 6.6 x 13 cm fluid collection between fascial layers of the right forearm. SAL resulted in the evacuation of 300 cc of coagulated blood. Post-operative CT imaging of the right upper extremity did not show any measurable fluid collection. Clinical exam demonstrated resolution of swelling and soft tissue compromise. The patient reported significant pain reduction, resumed her anticoagulation, and was discharged home. There were no notable complications at her three month post-operative visit. Consideration of a constant low-pressure SAL system can successfully treat MLL in the acute period. This system is relatively minimally invasive, results in faster healing times compared to open debridement, and still results in effective hematoma evacuation.

Highlights

Morel-Lavallée lesions (MLL) are traumatic closed soft tissue injuries that occur as a result of shearing forces that separate superficial and deep fascial layers
Ultrasound has been used as a diagnostic method; a case report by LaTulip et al highlights its utility in the emergency room where it is both cost-effective and accurate [5]
We present the first case report of using a closed suction-assisted lipectomy (SAL) system to treat an acute MLL of the upper extremity

Summary

Introduction

Morel-Lavallée lesions (MLL) are traumatic closed soft tissue injuries that occur as a result of shearing forces that separate superficial and deep fascial layers. Clinical features suspicious for MLL include a soft and fluctuant area of skin with possible ecchymosis, contour deformities, skin hypermobility, decreased sensation, or a palpable bulge to an area that has been subjected to tangential forces [1] These lesions can occur acutely or develop days after the injury depending on the mechanism and location [3]. Post-operative CT imaging did not show any measurable fluid collection (Figure 2) Her pressure dressing was removed on post-operative day 1, and clinical exam demonstrated resolution of swelling and soft tissue injury (Table 1). There were no notable complications at her three-month post-operative visit; all incisions were well healed (Figure 3)

Discussion

Conclusions

Disclosures