In cases where the lesion is heterogeneous in morphology or fluidfluid levels are present, the possibilities include 1,2. Morellavallee lesion mll is a posttraumatic closed degloving soft tissue injury because of shearing or tangential forces. Morellavallee lesions mll are rare, closed degloving injuries caused by trauma that delivers a shearing force to the soft tissue most commonly of the hip. We report a rare case of a large mll that was successfully treated with compression. Due to its broad differential diagnosis, a comprehensive evaluation beginning with history and physical examination are recommended. A morel lavallee lesion is a posttraumatic soft tissue degloving injury, originally described by french surgeon victor auguste francois morel lavallee in 1863. The morellavallee lesion is a closed internal degloving injury that results from tangential blunt pressure and shear stress that abruptly separates the skin and subcutaneous tissue from the underlying fascia. At one month, if there is a persistent fluid collection, then this may have become encapsulated. One week later the patient had reaccumulation of the fluid and the decision for surgical irrigation and debridement i and d with negative pressure wound dressing placement was made.
The treatment for your morellavallee lesion depends a bit on how long ago your injury was and the current nature of the lesion. Lower limb morellavallee lesion treated with shortstretch. This is commonly associated with sports injury caused by a shearing force. Similar to ultrasonographic imaging, fat and debris may be visualized as well as fluidfluid levels.
We present two cases that demonstrate a previously unrecognised association of the mll with thoracolumbar spine fractures. Depending on how early the ml lesion is diagnosed, conservative therapy may be enough in its management. Mri is the modality of choice for investigation of morellavallee lesion. Review open access morel lavallee lesion in children eun young rha1, dae ho kim2, ho kwon2 and sungno jung2 abstract morel lavallee lesion mll is a closed degloving injury resulting from blunt shearing or tangential forces. This lesion is rare and commonly missed however the patients prognosis depends on early detection of this lesion. A rare case of severe third degree friction burns and large morellavallee lesion of the abdominal wall. A rare case of severe third degree friction burns and large. Abstrak morellavallee lesion adalah kecederaan tisu lembut yang berlaku akibat. This lesion is characterized by the development of a fluid collection that, although originally described in the thigh, it has also been described in other anatomical sites. The morellavallee lesion mll is a rarely reported closed degloving injury, in which shearing forces. This condition was first decribed by french physician maurice morellavallee in the year 1853. Discussion the morellavallee lesion was first described by french surgeon francois morellavallee in 1863 2.
The lesions classically occur over the greater trochanter of the femur 1. The morel lavallee lesion is a rare soft tissue injury that occurs due to traumatic shearing force on skin surface causing separation of skin and subcutaneous tissue resulting in hematoma. Minimal invasive surgical treatment of morellavallee lesion mll. Results from surgical treatment of morellavallee lesions scielo. This was the first documented treatment of this lesion using endoscopic drainage. Morel lavallee lesions will appear as a discrete collection of fluid between the subcutaneous fat and underlying fascia. Mri features in five patients, which appears on page 1289 of this issue. Doppler flow activity is seen in the lesion or on the periphery. Morellavallee lesion in a professional american football. Pdf surgical management of morellavallee lesion researchgate. Since morellavallee first described the lesion in the 19th century, the term has been used to describe similar lesions in other anatomic sites such as the lumbar area and over the scapula 1, 2. Soft tissue pseudotumors of the pelvis and hip maj weston t.
B tangential shearing force cause the relatively mobile dermis and subcutaneous fat to move relative to the fixed underlying fascia, causing disruption of perforating arteries red, veins blue, and lymphatics green. Pdf the morellavallee lesion is a closed softtissue degloving injury commonly associated with highenergy trauma. Morellavallee lesion mll is an uncommon condition consisting of a closed degloving injury caused by forces that create pressure and shear stress between the subcutaneous tissue and the. Morellavallee lesions are posttraumatic, closed degloving injuries occurring deep to subcutaneous plane.
Minor residual changes after previous fluidfilled locule. A forgotten cause of bleeding in trauma khor cc, tan tl department of emergency medicine, faculty of medicine, universiti kebangsaan malaysia medical centre, jalan yaacob latif, bandar tun razak, 56000 cheras, kuala lumpur, malaysia. Pdf morellavallee lesion is a degloving injury occurring at the interface of the subcutaneous fat and the underlying fascia. I completed this cat after evaluating a patient with a morellavallee lesion. Morellavallee syndrome or lesion was first described by a french surgeon, victor morel lavallee, in 1863. The full text of this article is available in pdf format. This results in disruption of the vascular and lymphatic plexus and a cavity is created, filling with blood, lymph, liquefied fat and necrotic debris. This case report depicts a 22yearold gentleman who was involved in a motor vehicle accident. Can liposuction be used to treat a morellavellee lesion. The morel lavallee lesion is a closed internal degloving injury that results from tangential blunt pressure and shear stress that abruptly separates the skin and subcutaneous tissue from the underlying fascia. Morellavallee lesions are posttrauma closed soft tissue degloving injuries described infrequently in people. Lower limb morellavallee lesion treated with short. Morel lavallee lesion mll is an uncommon condition consisting of a closed degloving injury caused by forces that create pressure and shear stress between the subcutaneous tissue and the. Morel lavallee lesions are often overlooked initially, which can lead to a complicated course.
The morel lavallee lesion is a posttraumatic collection of fluid arising after a closed degloving injury has caused the separation of the skin and subcutis from the underlying muscular fascia. Review open access morellavallee lesion in children. Timely identification and management of a morel lavallee lesion is crucial because distracting injuries in the polytraumatized patient can result in a missed or delayed diagnosis. Knee joint effusion can be differentiated from other types of swelling by careful physical examination. Review open access morellavallee lesion in children eun young rha1, dae ho kim2, ho kwon2 and sungno jung2 abstract morellavallee lesion mll is a closed degloving injury resulting from blunt shearing or tangential forces. May 16, 2015 the treatment for your morel lavallee lesion depends a bit on how long ago your injury was and the current nature of the lesion. Chronic lesions tend to be more homogeneous with capsule formation 3, 6, 7. A total of 16 patients with persistent morellavallee lesions i.
The avulsion of subcutaneous tissue from deep muscle fascia results in the accumulation of haemolymph and necrotic fat, which can persist for several days to months after the inciting incident. Morel lavallee syndrome or lesion was first described by a french surgeon, victor morel lavallee, in 1863. Morellavallee lesions mlls classically occur in the greater trochanteric region, percentage of large mlls require surgical intervention, which comes with an increased risk of skin necrosis and infection. The lesion is usually compressible and without flow on doppler imaging. Morel lavallee lesion posttraumatic soft tissue injury first described by french physician maurice morel lavallee in 1853 1 degloving type injury where subcutaneous tissue is torn away from the underlying fascia 2 most commonly found in hippelvic region.
Both collections above extend along the entire lateral. Treatment of such lesions is still not well established. Morel lavallee lesion is a common but rarely described posttraumatic closed soft tissue injury sequel. Mine happened july 2017 but was not discovered until oct 2017. Morellavallee lesion in the upper extremity grant k. The morellavallee lesion in thoracolumbar spine traumatwo.
The readers attention is directed to the article titled longstanding morellavallee lesions of the trochanteric region and proximal thigh. The thigh, hip, and pelvic region are the most commonly affected locations. We describe the mri appearance of a morellavallee lesion. Ethical clearance was obtained from the institutional ethical committee. Morellavallee lesion is a posttraumatic, soft tissue degloving injury, involving separation of subcutaneous tissue. Morellavallee lesion initially diagnosed as quadriceps contusion. Pdf on apr 2, 2015, nicholas haydon and others published surgical management of morellavallee lesion find, read and cite all the research you need on. An external file that holds a picture, illustration, etc.
If in a classic location and with a characteristic appearance then little differential exists. The morel lavallee lesion is a closed softtissue degloving injury commonly associated with highenergy trauma. Ultrasound, mri, and importance of early intervention. If not treated in the acute and subacute setting these lesions. The right hip morellavallee lesion had a maximum width of 2. All identified morellavallee lesions were small figures 1 and 2. It presents as a hemolymphatic mass located over the external aspect of the thigh. The morellavallee lesion mll is a closed degloving injury caused by traumatic separation of the subcutaneous tissue from the underlying fascia, without a break in the overlying skin.
The most frequent mechanism of occurrence is posttraumatic, usually after degloving injuries. Morellavallee lesion mll is a closed degloving injury resulting from blunt shearing or tangential forces. The morel lavallee lesion mll is a closed degloving injury most commonly described in the region of the hip joint after blunt trauma. Doxycycline sclerodesis as a treatment option for persistent. Due to its inconsistent clinical manifestations and. Morellavallee lesion has become an eponym since maurice morel. We have observed that the mll also occurs in the knee as a result of shearing trauma during football, and is a distinct lesion from prepatellar bursitis and quadriceps contusion. The clinical manifestation of mll varies from soft fluctuant swelling to skin necrosis or wound sepsis.
Between january 2006 and december 20, we performed delayed surgical debridement on morellavallee lesions, after delimitation of the local tissue necrosis. Morellavallee lesions are a relatively rare clinical problem, referring to closed degloving injuries around the pelvis or. Between january 2006 and december 20, we performed delayed surgical debridement on morellavallee lesions, after delimitation of the local tissue necrosis, followed by closure through second intention andor use of graftsflaps. It was in my outer right thigh into my hip and buttocks by then. Results from surgical treatment of morellavallee lesions. The morellavallee lesion is a rare soft tissue injury that occurs due to traumatic shearing force on skin surface causing separation of skin and subcutaneous tissue resulting in hematoma.
Most of the patients sustained the lesion over the thigh followed by trochanteric region, lower back, and abdominal wall. The morellavallee lesion is a rare condition that was first described by the french physician maurice morellavallee in 1853. Morel lavallee lesions, strictly speaking, occur in the thigh. Yes, i have being trying to find others who have went through the destruction of a morel lavallee lesion. Dec 30, 20 morel lavallee lesion mll is a closed degloving injury resulting from blunt shearing or tangential forces. Morel lavallee lesions mlls classically occur in the greater trochanteric region, percentage of large mlls require surgical intervention, which comes with an increased risk of skin necrosis and infection. Percutaneous drainage of morellavallee lesions when the diagnosis is delayed m orel lavallee lesions are a closed internal degloving that occurs most commonly over the greater trochanter region, but can also occur in other regions, such as the knee. Part of the lesion overlies greater trochanter of femur. The lesion is caused by forces of pressure and shear stress at the borders of subcutaneous tissue to the muscle fascia or bone as they are seen in runover accidents. Traumatic swellingeffusion in the knee region is a relatively common presenting complaint among athletes and nonathletes. The authors report the case of a patient with morellavallee lesion in the knee after trauma and describe the main characteristics of the lesion.
Morellavallee lesion of the knee in a recreational frisbee. This lesion can occur after a shearing injury most commonly from a mva or fall of over 10 feet. There is very thin capsule pdf morellavallee lesion is a degloving injury occurring at the interface of the subcutaneous fat and the underlying fascia. The chain of events leading to the occurrence of this lesion is the formation of a potential space between the subcutaneous tissue and the firmly attached deep fascia, which. Percutaneous drainage of morellavallee lesions when the. Article information, pdf download for morellavallee lesion in the upper. Liposuction cannulas can easily drain fluid collections and could be helpful in removing necrotic tissue. Morellavallee lesion is a posttraumatic soft tissue degloving injury.
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