Postsurgical Bleeding Following the Treatment of a Chronic Morel-Lavallée Lesion

Abstract

Morel-Lavallée lesions are closed soft-tissue degloving injuries that occur when the skin and subcutaneous tissues are separated from underlying fascia as a result of a sudden shearing force. The space that is created has the potential to be filled with a mixture of blood, lymph fluid, or necrotic fat, which may easily become infected. The optimal treatment of Morel-Lavallée lesions is controversial. We present a case of a 29-year-old man who sustained pelvic fractures in a motorcycle accident and 1 year later presented with a painless, slowly expanding left thigh mass. Treatment, consisting of open debridement and primary closure, was complicated by significant postoperative bleeding requiring reoperation. The patient was followed clinically as an outpatient, and at 6-month follow-up he was doing well and had no evidence of recurrence of the lesion. Morel-Lavallée lesions are rare complications that are often missed or underappreciated at the time of initial injury. In many cases these lesions can persist for months before they are recognized. For long-standing Morel-Lavallée lesions, it is important to determine the nature of the fluid in the cavity before planning treatment. In the current case, it was unclear based on the official radiographic interpretation whether the lesion was filled with frank blood versus serous or serosanguineous fluid.