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The most common causes of Morel-Lavallée lesion include high-velocity trauma, crush injuries, and blunt trauma.10 This type of lesion occurs most frequently in the greater trochanteric region,11 a localization attributed to the region's bony prominence, its large relative surface area, the high mobility of the overlying skin allowing for significant shear stress, and the dense capillary network within the soft tissue of the proximal thigh and gluteal area.12, 13 Less common sites of involvement include the gluteal, scapular, and lumbosacral regions, as well as the abdominal area, calf/lower leg, and head.14 Morel-Lavallée lesions have also been reported in athletes following direct-blow sports injuries to the knee8 and can rarely occur after abdominoplasty and liposuction.
Presentation
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Anatomy
Morel-Lavallée lesions are closed injuries resulting from internal degloving of superficial soft tissues from the deeper fascial layers. This creates a cavity filled with lymph and blood (haemolymphatic collection). Most frequently found overlying the greater trochanter, particularly in the anterolateral thigh, due to mobile skin and tough underlying fascia (e.g., fascia lata). Less common are gluteal, scapular, lumbosacral regions, abdominal area, calf/lower leg, and head.
Indications
Contra Indications
Workup
- Clinical presentation
- Ultrasound
- MRI
Material
Essentials
- Ultrasound
- Chlorhexidine
- Sterile drapes
- Lidocaine 1% 10 ml
- 5F Introducer
- Needle
- Vibramycin (20 mg/ml)
- Syringes
- Compression bandage
Non Essentials
Positioning
- Dependant on the location of the lesion
Steps
- Time-out
- Sterile washing and draping
- Local anaestectic under ultrasound guidance
- Ultrasound guided puncture of the cyst
- Over the wire introduction of the 5F sheath
- Aspiration of the lesion content
- Installation of the Vibramycine
- Leave it in the cavity for 60 min
- Aspiration of as much as possible
- Apply compression bandage
- Sign-out
Tips & Tricks
- Early diagnosis is crucial to simplify treatment and reduce complications
- MRI is the investigation of choice for MLLs
- Compression bandaging alone has a limited role and should not be used for chronic lesions or most acute lesions
- Isolated percutaneous aspiration is generally ineffective and should be avoided
- Sclerodesis with doxycycline shows high efficacy for lesions up to 400 ml
- For open surgery, quilting sutures, curettage, and low suction drains are useful adjuncts for dead space closure
- Low suction drains should be left post-operatively until drainage is less than 30 ml over 24 hours.
- In pelvic trauma, defer definitive MLL management until after fracture fixation and wound healing to reduce deep infection risk
| Mild post-procedural paoin | common | |
| Infection | rare | |
- Tight compression bandaging for 4 weeks post-sclerodesis
Follow up
- Ultrasound follow-up after 4 weeks
Folder
Literature
Report
Time-out
Patient in rugligging. Wassen met chloorhexidine en steriel afdekken. Echogeleid punctie met 5F sheath. Aspiratie van ... ml helder vocht. Installatie van ... ml (20 mg/ml) Vibramycine. Aspiratie na 60 min. Drukverband gedurende 4 weken.
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