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Clinical Summary

Morel-Lavallée lesions are closed degloving injuries. They occur when the shearing forces of a high-energy trauma cause separation of the skin and subcutaneous tissue from the muscle fascia. This creates a dead space, allowing blood, lymph, and necrotic fat to collect. Drainage of this fluid is impaired since the vascular and lymphatic supply has been injured. Morel-Lavallée lesions are most commonly seen in the hip or proximal thigh.

As time passes after the injury, the collection of fluid becomes encapsulated, and this further prevents spontaneous drainage of the lesion. The diagnosis of a Morel-Lavallée lesion is typically made clinically. A swollen area with fluctuance of the soft tissue can be palpated. There may be overlying skin abrasions and ecchymosis. MRI is the most detailed study to characterize these lesions.

Management and Disposition

Initial management may be conservative with supportive care and compression dressings. However, once the collection of fluid becomes encapsulated, these patients should be referred to surgery for drainage. Complications of untreated lesions include infection and skin necrosis.

FIGURE 12.59

Morel-Lavallée Lesion. Hematoma associated with a Morel-Lavallée lesion in a lateral compression pelvic injury. (Reproduced with permission from Hall JB, Schmidt GA, Kress JP. Principles of Critical Care. 4th ed. New York, NY: McGraw Hill; 2015.)

FIGURE 12.60

Morel-Lavallée Lesion. Soft-tissue mass in the proximal calf. (Photo contributor: Chang Hyun Kim, MD. Reproduced with permission from Kim WJ et al. A Morel-Lavallée lesion of the proximal calf in a young trauma patient: A case report. Medicine (Baltimore). 2018;97(41):e12761.)

FIGURE 12.61

Morel-Lavallée Lesion. Intraoperative photograph showing the fibrous capsule of the Morel-Lavallée lesion. (Photo contributor: Karen M. Myrick, DNP. Reproduced from Myrick KM, Davis S. Morel-Lavallee injury a case study. Clin Case Rep. 2018;6(6):1033.)

FIGURE 12.62

Morel-Lavallée Lesion. Radiograph (A) showing soft-tissue opacity in the proximal calf, and ultrasound (B) demonstrating a hypoechoic fluid collection. (Photo contributor: Chang Hyun Kim, MD. Reproduced with permission from Kim WJ et al. A Morel-Lavallée lesion of the proximal calf in a young trauma patient: A case report. Medicine (Baltimore). 2018;97(41):e12761.)

FIGURE 12.63

Morel-Lavallée Lesion. MRI showing hyperintensity in the interfascial plane. (Photo contributor: Karen M. Myrick, DNP. Reproduced from Myrick KM, Davis S. Morel-Lavallee injury a case study. Clin Case Rep. 2018;6(6):1033.)

Pearls

  1. On bedside ultrasound, these lesions will appear as a homogenous anechoic or hypoechoic fluid collection. However, echogenic foci within the lesion may be seen ...

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