Minimal Invasive Surgical Treatment of Morel-Lavallee Lesion (MLL)

Special Article - Bariatric Surgery

Austin J Surg. 2017; 4(2): 1101.

Minimal Invasive Surgical Treatment of Morel-Lavallee Lesion (MLL)

Kharief A*, Sumra QA, Pedro, Eguare E and Tuir A

Surgical Department Radiology Department, Naas General Hospital, Ireland

*Corresponding author: Ahmed Kharief, Surgical Department Radiology Department, Naas General Hospital, Ireland

Received: May 17, 2017; Accepted: June 16, 2017; Published: June 23, 2017


Morel-Lavallee Lesion (MLL) is a post-traumatic closed degloving soft tissue injury because of shearing or tangential forces. A dead space will be created between the subcutaneous tissue and the underlying fascia. The space will be filled with heamolymphocel and liquefied fat. The patient presents with variable clinical features, ranging from a localized soft tissues fluctuant swelling to abscess formation or skin erythema with necrosis. So, main symptoms are localized pain which increases with movement, malaise and associated nausea and temperature following history of trauma such as motor vehicle accident or a fall. The common anatomical sites for these lesions are the greater trochanter, flank, buttocks and lumbodorsal regions and rarely may occur in the lower limbs as in our case. The MRI is the diagnostic image model of choice and it is vitally important for the radiologists to be aware of the clinical features and the radiological characteristics to be able to establish the diagnosis of Morel- Lavallee Lesion (MLL) in timely manner for an early appropriate treatment. The treatment approaches as they were reported in the literature involve conservative, open drainage and debridement of devitalized tissues as well as skin grafting when significant skin loss took place because of skin necrosis. Furthermore, it is necessary for these patients to have antimicrobial treatment cover to avoid sepsis and to main wound healing. We report a case of Morel- Lavallee Lesion (MLL) of the right leg post a fall at home ten months prior to the diagnosis she received treatment with Minimally Invasive Surgical intervention. Small incision was made and drainage of collection with negative pressure drainage system and compression stockings for six weeks. On follow up the outcome was excellent; the limb returned to normal size, the scars were small and hardy visible. So, based on the treatment outcome of our patient we conclude that Minimal Invasive Surgical intervention can be an option to treat a Morel-Lavallee Lesion (MLL).

Keywords: Morel-Lavallee Lesion; Degloving soft tissue injury; MRIMinimal Invasive Surgical intervention

Case Report

A 39 years old female, with past medical history of depression and recently diagnosed type-2 diabetes mellitus, presented to emergency department at 1600 hours with one day history of pain, redness and swelling of the right leg. Patient stated the pain was sudden in onset, severe, extended from right knee to right calf and was associated with nausea and increased sweating. The pain worsened during movement and improved by oral analgesics. She denied any history of fever, numbness or discoloration of toes. She did not use any anti-platelet or regular anti-coagulants.

However, patient reported that the swelling was first noticed 10 months ago, after she fell down a flight of stairs. At that time, she attended the emergency department after the fall and based on clinical examination and normal x-rays of the leg, a provisional diagnosis of hematoma was made and she was discharged on analgesics. However, during the next 10 months, patient had noticed repeated swelling and redness at the lateral aspect of leg that was diagnosed as cellulite is by general practitioner and treated with antibiotics at multiple occasions with no improvement. However, on this admission, the patient had severe acute pain along with previous on-going symptoms with no significant effect by analgesics.

She was regularly taking citalopram (for 2 years) and metformin (2 weeks). She was allergic to penicillin but during admission discovered to be allergic to Ciprofloxacin, Tazocin (tazobactam/piperacillin) and clindamycin.

Physical examination revealed a young obese female, lying comfortably in bed, with no signs of distress and vitally stable. On left lower leg examination showed a diffuse swelling and redness at the superolateral border of left lower limb extending from left knee to left ankle. The swelling was soft, fluctuant, warm and tender to touch. No laceration or ulceration was present. Her gait was normal; however, the swelling prevented the knee from full flexion. Examination of the contralateral limb was unremarkable.

Her blood reports revealed leukocytosis and elevated inflammatory markers. However, d-dimers were normal.

A sonogram and duplex scan was done to rule out deep venous thrombosis. But the sonogram showed a shallow discoid shaped fluid collection measuring 12cm in length within the deep soft tissues overlying the region of interest, suggestive of a haematoma. There was no evidence of deep venous thrombosis (Figure 1). Based on the sonographic evidence and lack of recent trauma/use of anticoagulation, an urgent MRI of the limb was conducted which revealed “a fusiform well defined encapsulated lesion between the subcutaneous fat and underlying fascia on the lateral side of right lower leg, starting at the level of right knee joint and extending along the upper two thirds of the right lower leg. It measured up to 20x10x3.4cm. It had mainly cystic contents of high T2 and low T1 signal. It also contained a few strands and fat globules and showed enhancement of its thin capsule with no remarkable changes in the underlying muscles and visible parts of the fibula (Figure 2). Based on the MRI findings, the diagnosis of a closed degloving injury, with the overall appearances suggestive of a Morel-Lavelle lesion (MLL) was made.