Development Of Granulation Tissue Research Articles

Symptom: Dizziness with Ear Pressure

Symptom: Dizziness with Ear Pressure

Vacuum-Assisted Wound Closure Therapy in Pediatric Lower Limb Trauma.

Although the importance of vacuum-assisted wound closure therapy has been well established as road to definitive treatment of trauma wound in the adult population, its use in pediatric patients is not well described in the literature. This study was conducted to evaluate the outcome of vacuum-assisted wound closure therapy in pediatric patients. Twenty-two patients were prospectively treated for soft tissue defect in lower limb using vacuum-assisted wound closure device, as these wounds were not amenable for primary closure. After wound evaluation, thorough wound debridement was done. Vacuum-assisted wound closure dressing was applied once hemostasis was achieved. Dressings were changed as per protocol. After the development of healthy granulation tissue, wound coverage was achieved with skin graft or flaps. Mean age of patients was 9.455 years, ranging from 4 to 14 years. Early, healthy granulation tissue had formed in all patients. The average number of vacuum-assisted closure (VAC) dressings required was 2.682. Average duration of VAC therapy was 8.045 days. The sizes of soft tissue defects reduced from an average 69.18 cm2 to 50.73 cm2 after VAC therapy with a mean decrease of 26.66%. There was no complication because of VAC therapy. Vacuum-assisted wound closure therapy accelerated the process of healthy granulation tissue formation, and thus shortened the healing time. VAC therapy lessens the morbidity and pain associated with large wounds in pediatric patients and brings cheer and smile in growing children.

Issues around vaginal vault closure

Key content Vaginal cuff dehiscence (VCD), vault prolapse, vaginal cuff granulation and infected vault haematoma are adverse events following hysterectomy. There are several approaches to closing the vaginal cuff, each using different techniques and sutures. Dehiscence of the vaginal cuff is more common with laparoscopic hysterectomy. Techniques that minimise excessive use of diathermy may reduce the risk of vault dehiscence. The incidence of post‐hysterectomy vault prolapse is estimated to be between 1.8% and 11.6%. McCall culdoplasty seems to be effective in supporting the vaginal vault. Different techniques are used to minimise the development of vault haematoma and granulation tissue. Learning objectives To understand the different techniques used for vault closure during hysterectomy. To understand the different surgical approaches used to reduce the risk of vault dehiscence, vault prolapse and haematoma after hysterectomy. To understand the post‐operative care procedure that should be followed after hysterectomy to minimise the risk of vaginal vault complications. Ethical issues Patients should be aware of the risk of vaginal vault dehiscence, vault prolapse, haematoma and granulation tissue formation after hysterectomy. Trainees should be well trained using simulators, be supervised when performing laparoscopic vaginal vault closure and be made aware that vaginal closure is another safe treatment option.

Necrotizing fasciitis, poor hygiene and negligence in obese patients

The Tegument, the body's largest organ, also fulfills the protective function by preventing the pathogens from penetrating into the body. The barrier, once overcome, opens the gate to serious illnesses with varying degrees of severity. We present the case of an obese patient aged 63, BMI 40, admitted to emergency service for necrotizing fasciitis in the abdominal wall. Anamnesis and general clinical examination highlight the presence of a large area of necrosis in the lower abdominal wall, affecting the iliac fossa, the hypogastric region and the left iliac fossa, lack of substance at this level, limited supraaponvrotic, with multiple sepsis, isolated tissue areas granulation, anfractum edges, suggestive aspect for necrotizing fasciitis. Serious surgical interventions have been carried out, with the aim of broad, digital and instrumental debridement, the important lavage of the wound with hydrogen peroxide and betadine and antibiotic treatment according to the antibiogram. Subsequently, dressings were applied with negative pressure, with development of granulation tissue in the wound and in the end was chosen for secondary suture with favorable outcome and discharge from the hospital 33 days after admission. Precarius socio-economic status, poor hygiene in an obese, careless patient, without identifying other causes like diabetes or surgical history, have led to the development of a multilingual, life-threatening condition. Serious surgical attitude and postoperative care have led to a medical success, although burdened by significant costs, which could have been avoided with minimal effort especially from the patient.

Silkworm Silk Matrices Coated with Functionalized Spider Silk Accelerate Healing of Diabetic Wounds.

Complex cutaneous wounds like diabetic foot ulcers represent a critical clinical challenge and demand a large-scale and low-cost strategy for effective treatment. Herein, we use a rabbit animal model to investigate efficacy of bioactive wound dressings made up of silk biomaterials. Nanofibrous mats of Antheraea assama silkworm silk fibroin (AaSF) are coated with various recombinant spider silk fusion proteins through silk-silk interactions to fabricate multifunctional wound dressings. Two different types of spider silk coatings are used to compare their healing efficiency: FN-4RepCT (contains a cell binding motif derived from fibronectin) and Lac-4RepCT (contains a cationic antimicrobial peptide from lactoferricin). AaSF mats coated with spider silk show accelerated wound healing properties in comparison to the uncoated mats. Among the spider silk coated variants, dual coating of FN-4RepCT and Lac-4RepCT on top of AaSF mat demonstrated better wound healing efficiency, followed by FN-4RepCT and Lac-4RepCT single coated counterparts. The in vivo study also reveals excellent skin regeneration by the functionalized silk dressings in comparison to commercially used Duoderm dressing and untreated wounds. The spider silk coatings demonstrate early granulation tissue development, re-epithelialization, and efficient matrix remodelling of wounds. The results thus validate potential of bioactive silk matrices in faster repair of diabetic wounds.

Comparison of Negative Pressure Wound Therapy v/s Conventional Dressing on Chronic Ulcers at Tertiary Health Centre

Introduction: Negative pressure wound therapy (NPWT) provides a novel option for wound treatment. Negative pressure wound therapy is a wound treatment method that subjects the wound bed to negative pressure by means of a closed system. Negative pressure wound therapy gives a moist wound healing environment that is essential for wound healing. Materials and Methods: The study was held in the surgery department of a tertiary care centre with total 50 numbers of patients of age 18 years and above. Patients were examined clinically, and necessary investigations done. Results: The difference in the rate of wound contraction was apparent since 5th day and by the time of discharge/intervention, means percentage of wound contraction was 90.9% in Negative pressure wound therapy as compared to 74.54% in conventional group patients. Mean hospital stay was significantly more in similar cases managed by conventional dressing as compared to Negative pressure wound therapy (17.23 vs 11.13 days). Conclusion: Present study showed that Negative pressure wound treatment appears to be a better option to conventional chronic wound dressings with early development of granulation tissue, rapid wound contraction and reduced hospital stay.

Evaluation of the efficacy of modern wound care dressings in the complex treatment of purulent wounds

Objective. Evaluate the efficacy of the treatment of purulent skin and soft tissue wounds using modern interactive dressings and conventional wound care dressings. Material and methods. The study included 160 patients, who were treated at the outpatient department of the Clinic of the SamGMU for the period from September 2018 to January 2019 after an autopsy, necrosectomy and drainage of purulent foci in the surgical hospital. Group I (n = 82) included patients, who applied Sorbalgon® interactive dressing (Paul Hartmann, Germany) during the first phase of the wound healing and Branolind® N atraumatic mesh dressing (Paul Hartmann, Germany) during the second phase of the wound healing for topical treatment of wounds in the postoperative period. Patients of Group II (n = 78) applied ointment dressings using Levomekol ointment during the first phase of the wound healing and Methyluracil ointment during the second phase of the wound healing. Patients in both groups received the same broad spectrum antibacterial therapy. In Group I, the dressings were applied once per 2 days, in Group II the dressings were applied on a daily basis. The researchers studied the following indicators: the nature of the wound discharge; the presence of edema and hyperemia of tissues; timing of the wound defect cleansing; temperature and leukocyte reactions of the body; crops on microflora and sensitivity to antibiotic therapy. Results. The study showed more pronounced dynamics of the temperature reaction normalization, reduction of the local inflammatory reaction and the leukocytosis level in patients of Group I. The wound cleansing from pus and fibrin, the development of granulation tissue on Day 5 were reported in 87.8% of patients of Group I and in 35.9% of patients of Group II, on Day 10 in 100% and 88.5% of patients, respectively. Conclusion. The use of Sorbalgon® and Branolind® N dressings improves the results of treatment of patients with purulent soft tissues pathology and reduces the risk for secondary infection, and improves the quality of life due to increase of interval between the dressings.

Multidisciplinary treatment of ischemic forms of diabetic foot

Purpose of the study. The phototherapy, platelet growth factor and coating materials in the treatment complex using for improve the results of wound treatment in patients with the ischemic form of diabetic foot.
 Materials and methods. The analysis of the results of treatment of 48 patients with ischemic forms of diabetic foot syndrome has been performed in the work. The patients were divided into the study and comparative groups. The patients were treated at the clinic of the State institution «V.I. Zaitsev Institute of General and Emergency Surgery National Academy of Medical Sciences of Ukraine» from 2012–2018, and all patients had II stage diabetes mellitus and IV degree of ischemia by Fontaine. Patients in both groups performed open and hybrid reconstructions. In the patients of the study group, the developed treatment technology was applied, containing phototherapy and photodynamic therapy with a range of: λ 470, 525 or 405 nm in the preoperative period, closure with synthetic coating with application plasma enriched of transforming growth factor.
 The implementation of the developed tactics allowed to achieve complete wound healing in 91,7% of patients, partial healing – in 8,3% of patients. The terms treatment terms for these patients did not exceed 2 months, high amputation was not required.
 Conclusions. Plastic closure of the wounds of the lower extremities after revascularization operations in an ischemic diabetic foot syndrome is indicated in cases where wounds do not tend to spontaneous healing. The use of a treatment complex consisting of phototherapy and photodynamic therapy, the closure of wounds with a synthetic coating of transforming growth factor is the effective stimulator of development of granulation tissue in the wound, suitable for further autodermoplasty.

Экспериментальная модель криодеструкции кожи

We suggest the in vivo experimental model of skin cryodestruction, suitable for studying the processes, occurring after skin neoplasm cryosurgery. To develop the model we have used low-temperature exposure using a cryoprobe, providing the temperature below the tissue cryoresistance threshold in the area of contact between the applicator working surface and skin. The initiation of destructive and inflammatory processes, both local and systemic, was observed in this model. Local morphological manifestations corresponded to the first phase of wound–healing process. We noted the destructive and inflammatory signs accompanied by primary necrosis (due to direct thermal damage), and a leukocyte bank and secondary necrosis (resulting from hemodynamic disorders). The reparative processes in injured tissues were manifested in developed granulation tissue. At a system level, the tissue cryodestruction was accompanied by the oxidative stress development (an increased content of lipid peroxidation products, a suppressed enzymatic component of antioxidant defense system) and an increased content of cerulloplasmin and C-reactive protein in blood serum. Probl Cryobiol Cryomed 2019; 29(1): 088–101

Complications of silicone Y stents placed due to malignant airway stenosis.

Malignant central airway obstruction around the main carina often requires placement of Y‑shaped stents. In this study, we aimed to determine the safety of silicone Y stents placed around the main carina in the malignant airway obstruction by examining the long term complications, emergence times and treatment approaches of complications. Between May 2012 and July 2015, 47 silicone Y stents were placed in 46 patients with malignant external compression or mixed type stenosis around the main carina. Patient stents were placed via rigid bronchoscopy under total intravenous anesthesia in operating room conditions. In the half of the patients (23/46), stents were placed under urgent conditions due to acute respiratory failure. Stents were deployed successfully in all the patients. No procedure related deaths were observed. The median time of survival following stent insertion was 157 days. The total long-term complication rate of silicone Y stents was 28.3%. Mucostasis (8.7%) and migration (2.2%) were observed within the first month after placement of the silicone Y stents (median 18 days), stent-edge granulation tissue development (13.0%) was observed at the earliest one month (median 64, range 34-386 days) and stent-edge tumor tissue development (4.3%) were observed at the earliest 3 months (median 151, range 85-217 days). A total of 7 (15.2%) stents were removed, 2 of which were due to mucostasis and 5 of which were due to granulation tissue development. One patient's stent was replaced with a longer silicone Y stent due to stent-edge tumor tissue development. The best palliative treatment of malignant tumor stenosis around the main carina is still silicone Y stent placement, but the long-term complication rate can be high. For this group of patients, bronchoscopy to be performed at the first and third months after silicone Y stent placement may provide early detection of stent-edge tissue development.

Effect of mitomycin-C applied through different approaches following tracheal surgery on development of granulation tissue and level of nephrotoxicity in rats.

This study aims to evaluate the effect of mitomycin-C applied through different drug administration approaches on the development of granulation tissue in the field of surgery and renal functions in rats which underwent tracheal surgery. Fifty male adult Sprague Dawley rats (weighing mean 200 g to 300 g) were divided into five groups. An incision was performed between the fifth and sixth cartilage ring of the trachea in all groups under anesthesia and the incision was primarily repaired with a 6/0 monofilament absorbable suture. A single dose of mitomycin-C 0.5 mg was applied in the experimental animals appropriate with their assigned groups as topical, intraperitoneal injection, injection to the wound edges, and through inhalation. No mitomycin-C was administered in one group which was accepted as the control group. Rats were sacrificed four weeks after surgery and their tracheas were excised subsequently. Tracheal tissue samples were histopathologically evaluated in terms of epithelization, fibrosis, amount of fibroblasts, angiogenesis, and inflammatory response. Diameter and wall thickness of the tracheas were measured. Blood urea and creatinine levels were evaluated for nephrotoxicity, and the rats were immunohistochemically examined for glomerular pathology. Epithelization was statistically significantly decelerated (p<0.01), diameter of the trachea was statistically significantly larger (p<0.05), and wall thickness of the trachea was significantly thicker in the group with topical mitomycin-C application compared to the control group (p<0.01). Topically applied mitomycin-C following tracheal surgery slows down epithelization and, thus, decreases the development of granulation tissue and maintains a wider diameter of the trachea.

Experience of stem cell use in treatment of skin burns

The results of three-year research on the use of allogeneic mesenchymal stem cells of adipose tissue (AMSCs) in the treatment of skin burns of II-III degree are presented. in a complex with wounds dressing of nanofibers chitosan and copolyamide, hyaluronic acid. It was found that with surgical necrectomy, introduction of AMSCs and substitution of defects with natural polymer coatings, the healing time is reduced by 89% (p &lt; 0.05). Isolated administration of MSC reduces the healing period by no more than 5% (p &gt; 0.05). The combined use of wounds dressings of nanofibers chitosan and copo lyamide with MSC accelerates the regeneration process by 26% (p &lt; 0.05), with the introduction of AMSCs accelerating the development of granulation tissue by the fifth day of observation by 83% (p &lt; 0.01). Joint use of wound coverings on the basis of hyaluronic acid with AMSCs is accompanied by an increase in the number of vessels of the microcirculatory bed in the defect area by 185% (p &lt; 0.01). Clinical evaluation of the effectiveness of drugs with stem cells – a gel for topical application and a suspension of MSC LC for injection administration demonstrate their ability to optimize regeneration in the burn zone. Application of gel with AMSCs reduces the duration of epithelialization of border (dermal) burns by 2.2-2.4 times, with the final healing period being reduced by 59% (p &lt; 0.01) and the suppuration frequency by 30% (p &lt; 0.05). The introduction of a suspension of AMSCs into the zone of deep burn increases the frequency of engraftment of autografts, stimulates angiogenesis and proliferation of fibroblasts in the superficial and deep layers of the dermis. In the area of MSC administration, the LC perfusion level and the amplitude of blood flow fluctuation are twice as high as the values in the zones without the introduction of cells.

Effects of Carvacrol, Thymol and essential oils containing such monoterpenes on wound healing: a systematic review

The treatment of wounds accounts for a considerable fraction of health expenses as well as serious socioeconomic problems. The use of natural substances stands out as a source of new therapeutic discoveries for the wound healing. Thus, this review compiled scientific findings on the applicability of carvacrol and thymol, or essential oils containing at least one of these compounds, for the treatment of wounds. This review was performed at PubMed, SCOPUS, Web of Science databases using keywords as wound healing, thymol/carvacrol and essential oils. Thirteen studies were selected for discussion. Thymol/carvacrol was able to act in the three phases of wound healing. In the first phase, they showed modulatory effect of the inflammatory cytokines, oxidative stress and antimicrobial power. In the second phase, they promoted re-epithelialization, angiogenesis and development of granulation tissue. Finally, in the third phase, they improve the collagen deposition and modulated the growth of fibroblasts and keratinocytes. These compounds present a high potential for the development of new therapeutic for wound repair. However, dose, efficacy and safety of these compounds for the treatment of wounds, as well as the mechanisms by which those effects can be observed, are challenges for future studies.

Feasibility of shotgun metagenomics to assess microbial ecology of pediatric tracheostomy tubes.

Biofilm formation on medical devices such as tracheostomy tubes (TTs) is a serious problem. The clinical impact of biofilms on the airway is still unclear. Biofilms may play a role in granulation tissue development, recurrent airway infections, and failure of laryngotracheal reconstructions. The microbial ecology on TTs has yet to be elucidated. The purpose of this study was to determine the feasibility of shotgun metagenomics to assess the biodistribution of microorganisms on TTs. Four TTs were collected from pediatric patients (1.4-10.2 years) with (n = 2) and without (n = 2) granulation tissue formation. Duration of TT placement prior to retrieval from patients ranged from 5 to 365 days. DNA extraction was performed using the MO BIO UltraClean Microbial Isolation (Mo Bio Laboratories, Carlsbad, CA). Library generation using Nextera XT adapters (Illumina Inc., San Diego, CA) and metagenomic shotgun sequencing was performed using the Illumina NextSeq500 (Illumina Inc, San Diego, CA). Salinibacter ruber, a species not found in mammalian microbiome communities, was used as a DNA standard and represented 0.7% to 5.7% of the microbiome, ensuring good quality and abundance of sample DNA. Metagenomic shotgun sequencing was successful for all patients. In TTs associated with granuloma, Fusobacterium nucleatum, Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae were predominant, most of which are considered pathogens. From TTs without granulomas, Neisseria mucosa, Neisseria sicca, Acinetobacter baumannii, and Haemophilus parainfluenzae were identified, primarily consistent with respiratory microbiome. This study reveals that metagenomic shotgun sequencing of biofilms formed on pediatric TTs is feasible with an apparent difference in microbiome for patients with granulation tissue. Further studies are necessary to elucidate the pathogenesis of microbial ecology and its role in airway disease in patients with TTs. 2c Laryngoscope, 129:317-323, 2019.

Anti-inflammatory and pro-healing impacts of exendin-4 treatment in Zucker diabetic rats: Effects on skin wound fibroblasts

Using male Zucker diabetic fatty (ZDF) rats implanted subcutaneously with polyethylene mesh pieces stimulating granulation tissue development, we investigated the effects of the in vivo and in vitro treatment with exendin-4, a glucagon-like peptide-1 agonist displaying a variety of antidiabetic actions, on the markers of metabolism, inflammation, and healing in addition to skin wound fibroblast/myofibroblast activities. Exendin-4 at increasing doses of 3–10 μg/kg or 0.9% saline was injected daily to ZDF rats pre-implanted with the mesh for 3 weeks. Then, fibroblasts/myofibroblasts isolated from the granulation tissue in both groups were further exposed in vitro to exendin-4 at concentrations of 0–100 nmol/l. After a 3-week administration period, cumulative food and water intake and body weight were reduced significantly. The serum and fibroblast culture medium C-reactive protein (CRP) concentrations and matrix metalloprotease-9/tissue matrix metalloproteinase inhibitor-1 (MMP-9/TIMP-1) ratio in the fibroblast culture medium were diminished significantly in the exendin-4 pretreated group, indicating the increased expression of anti-inflammatory and pro-healing biomarkers. In vivo exendin-4 treatment also increased the number of living fibroblasts/myofibroblasts in cell cultures. The subsequent in vitro exposure to exendin-4 significantly increased metabolic activity and total collagen content in fibroblast/myofibroblast colonies derived from exendin-4-pretreated rats but reduced the number of viable cells. A cytotoxic effect was noted at the highest exendin-4 concentrations used. To conclude, the treatment of diabetic rats with exendin-4 had beneficial effects on systemic and tissue metabolic, inflammatory, and healing markers and on fibroblast functions crucial for wound repair but showed some cytotoxicity on these cells.

Studying of the wound healing effect of ointment with groated leaves of Black Alder (Alnus Glutinosa) on the model of plane wound

The aim is to investigate the specific wound-healing effect of a new medicinal form – ointment with groated leaves of Black Alder on the model of a plane wound.Materials and methods. The wound healing effect of the new ointment with groated leaves of Black Alder was carried out on the model of a full-layer planar skin cut wound in rats with planimetric and morphological parameters in comparison with the preparation «Wundehyl».Results and discussion. It is established that the wound healing activity of the ointment with groated leaves of Black Alder was 1.84-4.76 times higher than the ointment «Wundehyl» in the rate of wound healing on the 9-15th day of application. Morphological analysis showed intensive epithelialization and development of granulation tissue during treatment with a new ointment.Conclusions. A new ointment with groated leaves of Black Alder showed the best wound healing effect on the control group and exceeded the reference preparation by 3.33 times, accelerating the healing of wounds for 3-4 days. The test dosage form can be considered a promising treatment for wounds.

Polypoid granulation tissue in pressure ulcers: Significance of describing individual ulcers

Granulation tissue formation is required for the healing of deep pressure ulcers. The wound healing process is often delayed at the stage of granulation tissue formation. The pathogenesis of pressure ulcers showing granulation tissue may vary; however, no terminology has been defined to describe existing ulcers. Thus, we previously defined terminology for granulation tissue to describe individual ulcers. Based on these terms, we retrospectively evaluated the findings of deep pressure ulcers. In particular, we focused on polypoid granular tissue, a unique morphological feature. Polypoid granulation tissues were frequently observed in pressure ulcers over the sacrum compared with those over the foot. Chronological observation of a few cases indicated that external forces from specific directions during the healing process caused the development of polypoid granulation tissue. In addition, most pressure ulcers showing polypoid granulation tissue exhibited a trench-like appearance in individual wounds. Based on these observations, polypoid granulation tissue may generate from specific external forces, which lead to wound deformity. Morphological findings in an individual wound may be useful to predict the mechanical factors on existing pressure ulcers.

Human peripheral blood mononuclear cells enriched in endothelial progenitor cells via quality and quantity controlled culture accelerate vascularization and wound healing in a porcine wound model

The transplantation of endothelial progenitor cells (EPCs) is used to promote wound angiogenesis. In patients with chronic wounds and accompanying morbidities, EPCs are often compromised in number and function. To overcome these limitations, we previously developed a quality and quantity controlled (QQ) culture system to enrich peripheral blood mononuclear cells (PBMNCs) in EPCs. To evaluate the wound healing efficacy of mononuclear cells (MNCs) harvested after QQ culture (QQMNCs), preclinical studies were performed on large animals. MNCs harvested from the blood of healthy human subjects were cultured in the presence of angiogenic cytokines and growth factors in a serum-free medium for 7 days. A total of 5 × 106 QQMNCs per full-thickness skin defect or control saline was injected into wounds induced in cyclosporine-immunosuppressed pigs. EPC colony-forming assays revealed a significantly higher number of definitive (partially differentiated) EPC colony-forming units in QQMNCs. Flow cytometry evaluation of QQMNC surface markers showed enrichment of CD34+ and CD133+ stem cell populations, significant reduction in CCR2+ cell percentages, and a greater than 10-fold increase in the percentage of anti-inflammatory M2-type macrophages (CD206+ cells) compared with PBMNCs. Wounds treated with QQMNCs had a significantly higher closure rate. Wounds were harvested, frozen, and sectioned at day 21 postoperatively. Hematoxylin and eosin staining revealed that the epithelization of QQMNC-treated wounds was more advanced than in controls. Treated wounds developed granulation tissue with more mature collagen and larger capillary networks. CD31 and human mitochondrial co-staining confirmed the presence of differentiated human cells within newly formed vessels. Real-time polymerase chain reaction (PCR) showed upregulation of interleukin 6 (IL-6), IL-10, and IL-4 in the wound bed, suggesting paracrine activity of the transplanted QQMNCs. Our data demonstrate for the first time that QQ culture of MNCs obtained from a small amount of peripheral blood yields vasculogenic and therapeutic cells effective in wound healing.

Assessment of the dynamics of bone edema in fractures of long tubular bones in children in the process of osteoregeneration according to magnetic resonance imaging

Children years old are distinguished by special mobility carelessness often neglect of danger and constitute the main concern of children s traumatologists Excessive reduction in the timing of immobilization of the limb is not always justified In the MRI study after manual repositioning and gypsum immobilization a wave like increase in signal intensity occurs reaching a maximum value on the th day after the trauma with further decrease The exception is a group of children of primary school age who have a high signal intensity for days MRI examination allows to assess the degree of severity of trabecular edema the development of granulation tissue and to predict the development of bone callus without radiation

MOREL-LAVALLEE LESION (MLL): case report and literature review on diagnosis and management of post-traumatic MLL in patients with polytrauma

Morel-Lavallee lesion has become an eponym since Maurice Morel-Lavallee described the first closed degloving injury in 1853. In present days, Morel-Lavallee lesion is still a rare condition resulting from blunt shearing of soft tissues due to trauma that separates the hypodermis from underlying fascia. The cavity that is created between the separated skin with subcutaneous tissue and fascia becomes filled with blood due to injury to perforating arteries as well as necrotic tissues. Although the MLL is often seen in traumatic injuries to lower extremities, mostly secondary to MVCs, however, they are also seen on trunk and buttocks.&#x0D; The closed cavity formed between subcutaneous tissue and fascia may remain unrecognized for some time. However, often the lesion is easily identified on CT or MRI as well as US images taken as part of complex work up of trauma patient or for soft tissue swelling in patient with history of blunt trauma. With time the closed cavity becomes organized secondary to inflammatory reaction and subsequent development of granulation tissue and the fibrous pseudocapsule. And as the pseudocapsule is formed around the contents of the MLL, patients often have no specific clinical symptoms, except for swelling of the site. The contents of the MLL thus may remain unrecognized for many days or even months.