Objective To investigate the surgical treatments of Morel-Lavallée lesion with perineal lacerations. Methods From March 2003 to June 2009, 18 cases of Morel-Lavallée lesion with perineal lacerations were treated. There were 16 males and 2 females with a median age of 28.5 years (range, 3-54 years). The time between the injury and hospital ization ranged from 3 hours to 7 days. The lesions were in the greater trochanter (2 cases), the gluteal (2 cases), the lumbar flank (1 case), the lumbar sacrum (3 cases), the pelvic girdle (7 cases), and the hip (3 cases). All the cases were compl icated with perineal lacerations, which included male genital ia defect (2 cases), mangled genital ia (2 cases), and genital ia injuries with anal injuries (14 cases). The main treatments included repeated debridement, external fixation of fractures, vacuum seal ing drainage, skin grafting, reconstruction of genital ia, and anoplasty. Results Three cases died after operation. Two cases died of multiple system organ failure, 1 case died of septic shock. Three cases were amputated and the causes were mangled extremities (2 cases) and osteofascial compartment syndrome (1 case). In 15 survivors, the average time of operations was 3.6 times (range, 3-8 times) and the average hospital ization days was 43.3 days (range, 32-108 days). After a follow-up of 6 months to 2 years, all perineal wounds healed. Anals recovered the normal defecation while one with ostomy was waiting for the secondly resetting of the bowels. Conclusion The treatments of Morel-Lavallée lesion with perineal lacerations were significantly different from simple close Morel-Lavallée lesion. With high mortal ity and disabil ity, Morel-Lavallée lesion with perineal lacerations require more challenging treatment protocols among which the most important is the soft tissue management and nutrition. The satisfactory outcomes come from joint efforts of multiple departments.
ObjectiveTo investigate the methods and effectiveness of one-stage operation for pelvis and acetabular fractures combined with Morel-Lavallée injury by internal fixation associated with vacuum sealing drainage (VSD). MethodsBetween June 2008 and October 2012, 15 cases of pelvis and acetabular fractures combined with Morel-Lavallée injury were treated. There were 5 males and 10 females, aged from 18 to 67 years (mean, 36.8 years). Fractures were caused by traffic accident in 11 cases and crashing injury of heavy object in 4 cases. The time from injury to hospitalization was 3 hours to 9 days (mean, 5.4 days). Morel-Lavallée injury located in the above posterior superior iliac spine in 4 cases, greater trochanter in 7 cases, and anterior proximal thigh in 4 cases. In 10 cases complicated by pelvic fracture, there were 1 case of anteroposterior compression type, 3 cases of lateral compression type, 5 cases of vertical shear type, and 1 case of compound injury type; in 5 cases complicated by acetabular fracture, there were 1 case of transverse fracture, 1 case of posterior wall and posterior column fracture, 1 case of transverse acetabulum plus posterior wall fracture, and 2 cases of both columns fracture. Open reduction and internal fixation were used to treat pelvic and acetabular fractures, and VSD to treat Morel-Lavallée injury. When the drainage volume was less than 20 mL/d, interrupted wound suture or free skin grafting was performed. ResultsThe hospitalization time was 16-31 days (mean, 20.8 days). Thirteen cases were followed up 4-16 months (mean, 7.8 months). The healing time of Morel-Lavallée injury was 16-36 days after operation (mean, 21.3 days). All the wounds had primary healing, and no infection occurred. The X-ray films showed that all fractures healed, with a mean healing time of 13.6 weeks (range, 11-18 weeks). At 6.5 months after operation, according to Majeed function scoring system in 8 cases of pelvic fracture, the results were excellent in 5 cases, good in 2 cases, and fair in 1 case; according to Harris hip scoring in 4 cases of acetabular fracture, the results were excellent in 2 cases, good in 1 case, and fair in 1 case. ConclusionTo pelvis-acetabular fractures combined with Morel-Lavallée injury, internal fixation treatment for fracture and VSD for Morel-Lavallée injury not only can cure merge Morel-Lavallée injury effectively, but also can guarantee the operation timing and incision safty of the pelvis-acetabular fractures.
ObjectiveTo investigate the effectiveness of channel screw combined with skin-stretching technique in treatment of pelvic fracture with severe Morel-Lavallée lesion.MethodsBetween January 2017 and May 2020, 11 patients with pelvic fractures complicated with severe Morel-Lavallée lesions were treated with channel screw combined with skin-stretching technique. There were 8 males and 3 females, with an average age of 39.2 years (range, 28-58 years). Causes of injury included traffic accident in 9 cases and falling from hight in 2 cases. The time from injury to hospital admission ranged from 1 to 6 days (mean, 3.7 days). According to the Tile classification, the pelvic fractures were rated as type C1 in 7 cases, type C2 in 3 cases, and type C3 in 1 case. The sites of Morel-Lavallée lesions were buttocks in 8 cases, hips in 2 cases, and thigh in 1 case. There was 1 case of rectal injury, 1 case of splenic rupture, 3 cases of craniocerebral injury, 2 cases of chest injury, 4 cases of spinal fracture, and 6 cases of sacral nerve injury. X-ray films were performed to observe reduction and healing of fracture. The quality of fracture reduction was evaluated by Matta standard at 1 week after operation. Wound healing and complications were observed. Majeed scoring was used to evaluate hip function and Gibbons sacral nerve injury grading was used to evaluate neurological function recovery.ResultsThe patients underwent 4-7 operations, with an average of 5.8 operations. The time of first operation (pelvic fracture fixation, debridement, and skin distractor installation) was 115-275 minutes, with an average of 186.5 minutes. The amount of intraoperative blood loss was 30-80 mL, with an average of 45.5 mL. All patients were followed up 6-12 months, with an average of 8.3 months. The quality of fracture reduction according to the Matta standard was excellent in 7 cases, good in 2 cases, and fair in 2 cases, with an excellent and good rate of 81.8%. All fractures healed at 3-6 months after operation, with an average of 4.5 months. At last follow-up, the hip functions were excellent in 7 cases and good in 4 cases according to Majeed scoring, with an excellent and good rate of 100%. Among the 6 patients complicated with sacral nerve injury, the Gibbons sacral nerve injury grading reached gradeⅠ for 4 cases, gradeⅡ for 1 case, and grade Ⅲ for 1 case. The wounds of 9 cases were sutured directly after skin-stretching treatment for 25-32 days, with an average of 28 days. The dermal edge necrosis occurred in 1 case, and the defect was repaired by free skin grafting. The skin superficial dry necrosis of the wound occurred in 1 case, and healed by dressing change.ConclusionIn the treatment of pelvic fracture complicated with severe Morel-Lavallée lesion, the channel screw and skin-stretching technique showed their own advantages, which can obtain early fracture fixation and good wound healing.
Morel-Lavallée lesions manifest as a type of subcutaneous closed degloving injury, where the external violence creates a potential space between the subcutaneous tissue and the deep fascia, leading to the accumulation of fluid and the formation of infection within the cavity. The primary causes of Morel-Lavallée lesions include high-energy trauma, blunt force injuries, or compression injuries, with the lesions typically located around the greater trochanter. Due to the potential for clinical oversight, these lesions may result in complications such as infection at the fracture site. In light of these circumstances, this article provides a comprehensive review of the etiology, epidemiology, pathological mechanisms, clinical manifestations, imaging features, differential diagnosis, complications, and treatment modalities of Morel-Lavallée lesions. The aim is to enhance the awareness of trauma orthopedic surgeons regarding this injury, thereby offering insights for clinical decision-making.