Morel Lavallee Lesion
If you have ever suffered a high-velocity trauma, such as a car accident or a fall from a height, you may have sustained a fracture of your pelvis, acetabulum, or femur. But did you know that you may also have a hidden injury that can cause serious complications if left untreated? This injury is called a Morel Lavallee lesion, and it is a type of closed degloving injury that affects the soft tissues of your body.
What is a Morel Lavallee lesion?
A Morel Lavallee lesion is a condition that was first described by a French surgeon named Maurice Morel-Lavallee in 1863. It occurs when the skin and the superficial fascia (the layer of tissue just below the skin) separate from the deep fascia (the layer of tissue that covers the muscles) due to a shearing force. This creates a potential space between the layers that fill with blood, lymph, and fat.
A morel lavallee lesion can occur in any part of the body where the skin is mobile over the deep fascia, such as the thigh, buttock, abdomen, or back. However, it is most commonly seen in the peritrochanteric region (the area around the greater trochanter of the femur) because this area is often exposed to high-energy trauma.
What are the symptoms of a morel lavallee lesion?
A morel lavallee lesion may not cause any symptoms at first, or it may be overshadowed by other injuries. However, as time passes, the lesion may grow in size and cause:
- Swelling
- Bruising
- Fluctuance (a feeling of fluid under the skin)
- Skin hypermobility (a feeling of skin sliding over the underlying tissues)
- Pain
- Infection
- Skin necrosis (death of skin tissue)
Morel Lavallee Lesion Vs Hematoma
| Morel Lavallee Lesion | Hematoma |
|---|---|
| Causes a potential space between the layers that fill with blood, lymph, and fat | A localized bleeding outside of the blood vessels that occurs due to disease or trauma |
| Usually associated with high-velocity trauma and underlying fractures of the pelvis, acetabulum, or femur | Can occur in any part of the body due to various causes such as injury, surgery, coagulation disorders, or medications |
| Causes a potential space between the layers that fills with blood, lymph, and fat | Causes a collection of blood within the tissues or a cavity |
| May not cause any symptoms at first or may be overshadowed by other injuries | May cause pain, swelling, redness, and bruising |
| May progress to form a capsule and become chronic if left untreated | May resolve spontaneously or become infected or calcified if left untreated |
| A closed degloving injury occurs when the skin and superficial fascia separate from the deep fascia due to a shearing force | Diagnosed by physical examination or imaging modalities that show the blood collection and its extent |
| Treated by conservative measures, percutaneous drainage, or surgical debridement depending on its size, location, and stage | Treated by rest, ice, compression, elevation, pain medications, or surgical drainage depending on its size, location, and cause |
How is a morel lavallee lesion diagnosed?
A morel lavallee lesion can be difficult to diagnose because it may not be visible on plain radiographs or CT scans. The best imaging modality for detecting a morel lavallee lesion is MRI, which can show the fluid collection and its relationship with the surrounding tissues. Ultrasound can also be used to locate and measure the lesion and guide percutaneous treatment.
How is a morel lavallee lesion treated?
The treatment of a morel lavallee lesion depends on its size, location, and stage. The stages of a morel lavallee lesion are:
- Stage 1: Acute stage (within 72 hours of injury). The fluid collection is not encapsulated and can be easily drained.
- Stage 2: Subacute stage (between 72 hours and 6 weeks of injury). The fluid collection starts to form a capsule and becomes more viscous and difficult to drain.
- Stage 3: Chronic stage (after 6 weeks of injury). The fluid collection is fully encapsulated and becomes solidified and fibrotic.
The treatment options for a morel lavallee lesion include:
- Conservative treatment: This involves compression bandages, elevation, rest, ice, and antibiotics. This may be sufficient for small lesions in the acute stage.
- Percutaneous drainage: This involves inserting a needle or catheter into the lesion and aspirating the fluid. This may be effective for moderate lesions in the acute or subacute stage.
- Surgical debridement: This involves making an incision over the lesion and removing the fluid and capsule. This may be necessary for large or chronic lesions that do not respond to other treatments.
How can a morel lavallee lesion be prevented?
The best way to prevent a morel lavallee lesion is to avoid high-velocity trauma. However, if you do suffer such an injury, you should seek medical attention as soon as possible and inform your doctor about any signs or symptoms of a morel lavallee lesion. Early diagnosis and treatment can prevent complications and improve outcomes.
What are the Complications of Morel Lavallee Lesion
- Infection of the fluid collection
- Capsule formation and recurrence of the lesion
- Skin necrosis and cosmetic issues
- Neurovascular injury and chronic pain
Conclusion
A morel lavallee lesion is a hidden danger of high-velocity trauma that can cause serious problems if left untreated. It is a type of closed degloving injury that occurs when the skin and superficial fascia separate from the deep fascia due to a shearing force. It can cause swelling, bruising, pain, infection, and skin necrosis. It can be diagnosed by MRI or ultrasound and treated by conservative measures, percutaneous drainage, or surgical debridement depending on its size, location, and stage.
If you have suffered a high-velocity trauma or suspect that you have a morel lavallee lesion, you should consult your doctor as soon as possible. Early intervention can prevent complications and improve your quality of life.
References
(1) Morel-Lavallée lesion | Radiology Reference Article – Radiopaedia.org.
(2) Morel-Lavallee Lesion – Trauma – Orthobullets.
(3) Morel Lavallee Lesion – StatPearls – NCBI Bookshelf.
FAQs
What is a morel lavallee lesion?
A morel lavallee lesion is a type of closed degloving injury that occurs when the skin and superficial fascia separate from the deep fascia due to a shearing force. It creates a potential space between the layers that fill with blood, lymph, and fat.
What causes a morel lavallee lesion?
A morel lavallee lesion is usually caused by high-velocity trauma, such as a car accident or a fall from a height. It is often associated with underlying fractures of the pelvis, acetabulum, or femur.
What are the symptoms of a morel lavallee lesion?
A morel lavallee lesion may not cause any symptoms at first, or it may be overshadowed by other injuries. However, as time passes, the lesion may grow in size and cause swelling, bruising, fluctuance, skin hypermobility, pain, infection, and skin necrosis.
How is a morel lavallee lesion diagnosed?
A morel lavallee lesion can be difficult to diagnose because it may not be visible on plain radiographs or CT scans. The best imaging modality for detecting a morel lavallee lesion is MRI, which can show the fluid collection and its relationship with the surrounding tissues. Ultrasound can also be used to locate and measure the lesion and guide percutaneous treatment.
How is a morel lavallee lesion treated?
The treatment of a morel lavallee lesion depends on its size, location, and stage. The stages of a morel lavallee lesion are:
- Stage 1: Acute stage (within 72 hours of injury). The fluid collection is not encapsulated and can be easily drained.
- Stage 2: Subacute stage (between 72 hours and 6 weeks of injury). The fluid collection starts to form a capsule and becomes more viscous and difficult to drain.
- Stage 3: Chronic stage (after 6 weeks of injury). The fluid collection is fully encapsulated and becomes solidified and fibrotic.
The treatment options for a morel lavallee lesion include:
- Conservative treatment: This involves compression bandages, elevation, rest, ice, and antibiotics. This may be sufficient for small lesions in the acute stage.
- Percutaneous drainage: This involves inserting a needle or catheter into the lesion and aspirating the fluid. This may be effective for moderate lesions in the acute or subacute stage.
- Surgical debridement: This involves making an incision over the lesion and removing the fluid and capsule. This may be necessary for large or chronic lesions that do not respond to other treatments.
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