Page 127 - Journal of Special Operations Medicine - Spring 2016

effusion becoming infected and result in development present an infection risk, particularly with Pseudomo-

of extensive skin necrosis. Morel-Lavallée lesions can be nas. Furthermore, this case highlights the utility of US,
missed up to 44% of the time, which underscores the a tool increasingly prevalent in the austere environment
importance of including this diagnosis in the appropri- for evaluating soft tissue injury.
8
ate clinical context. Pseudomonas aeruginosa has been
reported in resulting necrotic tissue from Morel-Lavallée Disclosures
lesions, which can spread quickly to involve the entire
cavity of injury. Hak et al. reviewed 24 cases of closed The authors have nothing to disclose
9
degloving injuries; positive cultures were reported in
which 11 of the cases resulted. The results were not de- References
pendent on the time frame from injury to diagnosis and
debridement. 2 1. Nickerson T, Zielinski M, Jenkins D, et al. The Mayo Clinic
experience with Morel-Lavallée lesions: establishment of a
practice management guideline. J Trauma Acute Care Surg.
Treatment options vary based on size of the lesion. 2014;76:493–497.
Smaller lesions are typically managed conservatively 2. Hak D, Olson S, Matta J. Diagnosis and mangement of closed
with compression or needle aspiration. Nickerson et internal degloving injuries associated with pelvic and acetabu-
10
al. published their practice management guideline based lar fractures: the Morel-Lavalée lesion. J Trauma. 1997;42:
on a cohort of 79 patients with 87 Morel-Lavallée le- 1046–1051.
sions resulting from trauma. Their research showed an 3. Vanhegan I, Dala-Ali B, Verhelst L, et al. The Morel-Lavallée
lesion as a rare differential diagnosis for recalcitrant bursitis
83% recurrence in patients whose initial aspiration was of the knee: case report and literature review. Case Rep Or-
greater than 50mL in volume. Therefore, an initial as- thop. 2012;2012:593193.
piration volume of greater than 50mL has become the 4. Hefny AF, Kaka LN, El Nazeer AS, et al. Unusual case of
benchmark to proceed to operative intervention. Larger life threatening subcutaneous hemorrhage in a blunt trauma

patient. Int J Surg Case Rep. 2015;15:119–122.
lesions and those with aspiration volumes in excess of 5. Hudson DA, Knottenbelt JD, Krige JE. Closed degloving in-
50mL typically require incision, drainage, and vacuum juries: results following conservative surgery. Plast Reconstr
dressing application. Presence of a capsule would render Surg. 1992;8:853–855.
1
conservative or percutaneous treatment unsuccessful, 6. Bonilla-Yoon I, Masih S, Patel D, et al. The Morel-Lavallée le-
11
thus leading to recurrence if not managed surgically. sion: pathophysiology, clinical presentation, imaging features,
and treatment outcomes. Emerg Radiol. 2014;21:35–43.
Percutaneous drainage and sclerodesis using talc and 7. Nair A, Nazar P, Sekhar R, et al. Morel-Lavallée lesion: a
doxycycline have also been reported to be effective. 12 closed degloving injury that requires real attention. Indian J
Radiol Imaging. 2014;24:288–290.
8. Kottmeier S, Wilson S, Born C, et al. Surgical management
Conclusion of soft tissue lesions associated with pelvic ring injury. Clin
Orthop Relat Res 1996;(329):46–53.
The Servicemember in this case had a classic shearing- 9. Kim S, Roh S, Lee N, et al. Clinical experience of Morel-
type mechanism precipitating his injury. As a result of Lavallée syndrome. Arch Plast Surg. 2015;42:91–93.
limited clinical experience among providers caring for 10. Harma A, Inan M, Ertem K. The Morel-Lavallée lesion: a
Morel-Lavallée lesions and their varying symptoms, conservative approach to closed degloving injuries. Acta Or-
treatment of these lesions varies widely. The Service- thop Traumatol Turc. 2004;38:270–273.
member described in this case was evaluated at a ter- 11. Gilbert BC, Bui-Mansfield LT, Dejong S. MRI of a Morel-
Lavallee lesion. AJR Am J Roentgenol. 2004;182:1347–1348.
tiary care center by a plastic surgeon. The determination 12. Tejwani SG, Cohen SB, Bradley JP. Management of Morel-La-
was made to manage this patient conservatively. He was vallee Lesion of the knee: twenty-seven cases in the National
followed as an outpatient for 6 weeks, with eventual Football League. Am J Sports Med. 2007;35:1162–1167.
resolution in his back lesion.

This case highlights the importance of considering the
mechanism of injury in forming a differential diagno- Ms Callahan serves as a civilian nurse practitioner with the
sis. In this instance, the history of a shearing mecha- Department of Emergency Medicine, Blanchfield Army Com-
nism prompted the consideration of this entity. The key munity Hospital, Fort Campbell, Kentucky.
to making the diagnosis of a Morel-Lavallée lesion is MAJ Eisenman serves as a staff emergency physician with
having an awareness of the clinical importance of this the Department of Emergency Medicine, Blanchfield Army
injury. Of particular importance in the operational Community Hospital, Fort Campbell, Kentucky. E-mail:
environment is recognizing Morel-Lavallée lesions as Justin.c.eisenman.mil@mail.mil.
a potential source for hemorrhage. These lesions also

Morel-Lavallée Lesion 111