Abstract: Morel-Lavallee lesion has been described as a post-traumatic soft tissue degloving injury. It is commonly seen in association with road traffic accidents or sports injuries where there is separation of the hypodermis layer from the deeper fascia caused by a shearing force. These injuries occur around the mid-torso, specifically at the flank, lumbar spine, scapula, buttocks and the knee but are most commonly seen over the greater trochanter. There is a complex serosanguinous fluid collection containing blood, lymph and necrotic material within the separated tissue planes. Various treatment modalities like compression bandaging, sclerodesis, percutaneous aspiration, open debridement, quilting sutures and VAC (vacuum assisted closure) therapy have all been described in literature, however a clear consensus on the management protocol does not exist.
Herein we reported a 45 year old gentleman who presented with a persistent fluctuant swelling over his left thigh following a motor vehicle accident. He had a history of multiple aspirations of the collection. Upon presenting to our Institute he underwent incision and drainage with sclerotherapy followed by open drainage and debridement with low suction drains. However on follow up visits there was recurrent swelling over the inferior most dependent aspect of the lesion which was finally managed by VAC therapy. The patient eventually returned to normal activity after 4 months from the initial injury with no residual loss of function.
The clinical significance of this case is to emphasize that a high degree of suspicion and early use of imaging modalities like MRI in suspected patients are essential to provide timely and appropriate treatment. We also aim to discuss the efficacy of various forms of treatment as per the available literature which shows that a low threshold for operative management is associated with lower recurrence and complication rates.
