Session IV - Pelvis

Morel-Lavallee Lesions Treated with Debridement and Dead Space Closure

DuWayne A. Carlson, MD; Julia Simmons, RN; William Sando, MD; Timothy G. Weber, MD; Orthopaedics Indianapolis and Methodist Hospital, Indianapolis, Indiana, USA

Purpose: Numerous methods of treating closed or open degloving injuries (Morel-Lavallee lesions) have been reported. The currently recommended technique uses multiple debridements with ultimate skin grafting or healing by secondary intervention. A protocol has been developed at our institution that involves a single operative intervention for closed and acute open injuries. The purpose of this study was to retrospectively evaluate the efficacy of this treatment protocol for Morel-Lavallee lesions.

Methods: Open lesions were treated the day of injury, and closed lesions were treated either at the time of fracture fixation or on a delayed basis if not in the operative field. Debridement removed all nonviable tissue. Closure was meticulous in eliminating the dead space by using sutures from fascia to the fat layer, dermis, or through the skin, with dental bolsters placed every 4 to 5 sq. cm. Drains were left in place until dry. Lesions that were open and infected on transfer of care were treated with two debridements and antibiotics until the drains were discontinued. Routine closure was performed at the second debridement.

Results: Fifteen Morel-Lavallee lesions were found in 14 patients, 7 men and 7 women with a mean age of 36 years. Locations of the lesions included lateral thigh to trochanter, 11; medial thigh, 2; anterior pelvis, 1; and presacral, 1. Six lesions were open and nine were closed. Three of the six open lesions were initially treated by other surgeons and were infected on initial evaluation. One closed injury was treated with percutaneous drainage and with percutaneous skin-to-fascia sutures. This wound became secondarily infected and was treated by using the open infected protocol. Each wound went on to full healing without infection. Two wounds had local wound problems that healed with only local wound care. One of these two wounds was evaluated in the operating room because of possible deep extension but was found to be locally limited.

Discussion: Morel-Lavallee lesion management with aggressive debridement and meticulous dead space obliteration appears to be a very viable option. This approach may avoid multiple trips to the operating room for redebridement associated with currently used treatment protocols.