Morel-Lavallée lesion

Background

• Posttraumatic, closed degloving injury
• Results in subcutaneous fluid collection after abrupt separation of skin and subcutaneous tissues from underlying fascia
  • Disrupts capillaries and lymphatics resulting in leakage of lymph, blood, and necrotic fat
• Most commonly seen in proximal thigh or overlying hip
  • Also reported in trunk, prepatellar region, lumbar region, or scapular regions
• If not diagnosed early, can become infected

Clinical Features

• Enlarging, painful area of swelling
• Soft tissue fluctuance
• Associated with high-energy, blunt trauma with or without associated fracture

Differential Diagnosis

• Hematoma
• Hemangioma/Vascular malformation
• Tumor
• Cyst
• Abscess
• Deep venous thrombosis
• Compartment syndrome
• Septic joint
• Necrotizing fasciitis

Extremity trauma

• Compartment syndrome
• Contusion
• Crush syndrome
• Degloving injury
  • Morel-Lavallée lesion
  • Ring avulsion injury
• Fracture
  • Open fracture
• Laceration
• Myositis ossificans
• Open joint injury
• Peripheral nerve injury
• Rhabdomyolysis
• Tendon injury
• Vascular injury

Skin and Soft Tissue Infection

• Cellulitis
  • Hand cellulitis
  • Facial cellulitis
  • Orbital cellulitis
• Erysipelas
• Lymphangitis
• Folliculitis
• Hidradenitis suppurativa
• Skin abscess
  • Anorectal abscess
  • Bartholin gland abscess
  • Pilonidal abscess
  • Scrotal abscess
• Necrotizing soft tissue infections
  • Necrotizing fasciitis
  • Necrotizing myositis
  • Necrotizing cellulitis
  • Fournier's gangrene
• Mycobacterium marinum

Look-A-Likes

• Sporotrichosis
• Osteomyelitis
• Deep venous thrombosis
• Pyomyositis
• Purple glove syndrome
• Tuberculosis (tuberculous inflammation of the skin)

Evaluation

• Evaluate for tenderness, fluctuance
• Labs
  • CBC- can have significant bleeding into the lesion, watch Hb
• Imaging
  • MRI is modality of choice for evaluation, but these lesions are also visible on CT
  • Ultrasound can show a fluid collection, but can't be used to rule out

Management

• Will require surgical consultation and drainage

Disposition

• Admit