Although this study has limited numbers, it provides enough guidance to suggest a consistent way of managing it. It may occur by a highenergy trauma, direct bruises, or sports injuries, usually in trochanteric area. Pdf morellavallee lesion is a posttraumatic soft tissue degloving injury. Morellavallee lesion mll occurs when there is a collection of haemolymph due to the. Joint space well preserved, subchondral bone smooth surface s. The authors report the case of a patient with morellavallee lesion in the knee after trauma and describe the main characteristics of the lesion.
The morel lavallee lesion is recognized by any orthopedic surgeon, but rarely mentioned in medical literature. 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. Morel lavallee lesion mll was rst reported by the french physician maurice morel lavallee in. Differential diagnosis includes ganglion cyst, fat necrosis, sarcoma, hemangioma, subcutaneous hematoma, aneurysmal bone cyst. Diagnosis and management of closed internal degloving injuries associated with pelvic and acetabular fractures. The importance of morellavallee lesion in medicolegal evaluation. However, similar biomechanical forces to the lumbar region, over the scapula, or over the knee can result in identical lesions and these are often also called morellavallee lesions 1,3. Early, the cavity fills with blood, lymph, and fat. A morel lavallee lesion is a closed traumatic softtissue degloving injury, caused by separation of the hypodermis from the underlying fascia. Apr 29, 2012 morel lavallee lesions mll are rarely diagnosed posttraumatic sequel. The morel lavallee lesion can be challenging to treat. Morellavallee lesion is a rare cause of subcutaneous swelling, caused by posttraumatic shearing of the hypodermis from the underlying fascia. Diagnosis and management of closed internal degloving. The morellavallee lesion mll is a closed traumatic softtissue degloving injury.
Postsurgical bleeding following the treatment of a chronic morel. Morel lavallee lesions of the hip and knee, and postoperative lymphoceles 69. Dec 30, 20 morel lavallee lesion mll is a closed degloving injury resulting from blunt shearing or tangential forces. The space formed by the degloving injury may then be filled with liquefied fat, lymph, or blood from the disrupted blood vessels and lymphatics. Morellavallee lesions are a form of closed degloving injury that leads to fluid accumulation and the formation of a pseudocyst. Morellavallee lesion mll entity represents as a haemolymph mass as a result of. Pdf morellavallee lesion of the lower back mimicking an. It is therefore mandatory to combine percutaneous drainage with. There are 120 terms under the parent term lesion of in the icd10cm alphabetical index. Doppler flow activity is seen in the lesion or on the periphery. 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. Morel lavallee lesions in orthopedics healios wound solutions. These lesions developed in male and 3 female patients mean age 41 years. Morellavallee lesions mll are rare, closed degloving injuries caused by trauma that delivers a shearing force to the soft tissue most commonly.
Morel lavallee lesions are frequently misdiagnosed. We describe the case of a patient who presented with recurrent thigh pain after multiple stab. Pdf morellavallee lesion mll is a closed degloving injury resulting from blunt shearing or tangential forces. The morel lavallee lesion as a rare differential diagnosis for recalcitrant bursitis of the knee. We have observed that the mll also occurs in the knee as a result of shearing trauma during football, and is a distinct lesion. Morellavallee seroma mls or posttraumatic pseudocyst is a soft tissue seroma developing due to closed degloving injury by a shearing. We treated 16 morellavallee lesions between may 2005 and december 2008. Morel lavallee syndrome or lesion was first described by a french surgeon, victor morel lavallee, in 1863. Although a wellknown entity, there are no statistical data available in the literature to support the prevalence of mll. Morel lavallee lesion in children morel lavallee lesion in. Between january 2006 and december 20, we performed delayed surgical debridement on morellavallee lesions, after delimitation of the local tissue necrosis. Pdf a closed degloving injury, or morellavallee lesion, is the result of a severe, traumatic, shearing injury, causing separation of the skin and.
A morel lavallee lesion mll involves posttraumatic fluid collection around the greater trochanter. Diagnosis is through a combination of clinical examination, history, and imaging studies. Review open access morellavallee lesion in children. Magnetic resonance imaging mri is the modality of choice for characterization. Morellavallee lesion initially diagnosed as quadriceps contusion. Prepatellar morel lavallee effusion closed degloving injury lateral radiograph of the left knee shows prepatellar soft tissue. Doxycycline as sclerotherapy for recurrent aseptic olecranon bursitis, a new application of an existing therapy erik close and gregory hill. Knee joint effusion can be differentiated from other types of swelling by careful physical examination. Due to its broad differential diagnosis, a comprehensive evaluation beginning with history and physical examination are recommended. In this condition, hemolymph is collected in the closed space between the separated subcutaneous tissue and the.
The lesion is frequently missed, or its significance is overlooked, on. We present two cases in which mll was missed at the initial evaluation. We describe the diagnosis of such a lesion through the use of ultrasound imaging in the emergency department to utilize a fast, costeffective imaging technique that does not. 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. 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 lesions classically occur over the greater trochanter of the femur 1.
The french physician, victoraugustefrancois morellavallee, first described the lesion in 1863. Doxycycline sclerodesis as a treatment option for persistent. The morellavallee lesion mll is a rarely reported closed degloving injury, in which shearing forces. In a 4year period, 24 mri studies of 24 consecutive. Morellavallee lesions mll, is one of the most important type and is a significant. It presents as a hemolymphatic mass located over the external aspect of the thigh. It most frequently occurs in the peritrochanteric region along the proximal lateral thigh, 1 such as in this ct scan. This is commonly associated with sports injury caused by a. Morellavallee lesions are closed internal degloving injuries, secondary to trauma of the proximal femur and pelvis, where the subcutaneous tissue is torn away. Bony structure appear normal in regard to contour, size, number, and position relative to adjacent bones b.
It is caused by a vertical shearing force which causes closed internal. Part of the lesion overlies greater trochanter of femur. Acute lumbar morellavallee haematoma in a 14yearold boy. The mechanism of the injury is a sudden violent shear stress to the anterolateral thigh.
The thigh, hip, and pelvic region are the most commonly affected locations. Morellavallee syndrome or lesion was first described by a french surgeon, victor morel lavallee, in 1863. 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. Mri, t1weighted sequence a and stir sequence b demonstrating a fluid collection with fat foci within the lesion arrows. Morel lavallee lesion is a common but rarely described posttraumatic closed soft tissue injury sequel. Percutaneous drainage of morellavallee lesions when the. Kumar s, kumar s 2014 morel lavallee lesion in distal thigh.
May 16, 2015 when that is the case, the morel lavallee lesion behaves much like a chronic seroma and may need to be surgically excised. 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 icd10cm alphabetical index is designed to allow medical coders to look up various medical terms and connect them with the appropriate icd codes. The full text of this article is available in pdf format. They follow closed degloving injuries due to accumulation of blood and debris in the subcutaneous plane.
Though they are not uncommon, they are rarely diagnosed which results in delay in their treatment. Morellavalee lesions treated with debridement and meticulous dead space closure. The therapeutic challenges of degloving softtissue injuries latifi r. Results from surgical treatment of morellavallee lesions scielo. 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 posttraumatic collection of fluid arising after a closed degloving injury has caused the separation of the skin and subcutis from the underlying muscular fascia. Morellavallee lesions, strictly speaking, occur in the thigh. A morellavallee lesion is a closed degloving injury associated with severe trauma to the pelvis. Cancellous and cortical bone appear of normal contrast c. 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. Can liposuction be used to treat a morellavellee lesion. The morellavallee lesion was described by the french physician maurice morellavallee in 1853. The clinical manifestation of mll varies from soft fluctuant swelling to skin necrosis or wound sepsis. Pdf medicolegal considerations for morellavallee lesions. Morellavellee lesions are soft tissue degloving injuries resulting from shearing trauma that induces separation of the superficial and deep fascias creating a.
We aimed to describe the clinical presentation and management of. The right hip morellavallee lesion had a maximum width of 2. The morellavallee lesion is a rare condition that was first described by the french physician maurice morellavallee in 1853. As the lesion evolves, blood is reabsorbed and replaced with serosanguinous fluid, 3, 6 contributing to the tendency of these. Morellavallee lesion mll is a closed degloving injury resulting from blunt. Introduction closed degloving injury is a severe traumatic separation between the skin and subcutaneous tissue underlying the fascia. The importance of morellavallee lesion in medicolegal. Kesimpulannya, morellavallee lesion adalah kecederaan tisu lembut yang jarang berlaku tetapi mampu menyebabkan pendarahan yang serius selepas trauma berlaku. Therefore, the finding of a capsule on imaging could be used to help select the appropriate course of treatment. Rapid diagnosis in the emergency department could significantly improve patient outcomes. Introduction morel lavallee lesion mll is an infrequent or underreported serious consequence of closed degloving injuries. The lesion is often seen in trauma patients and is usually caused by a blunt injury in which large tangential forces displace subcutaneous adipose tissue and. Ultrasound utility in the diagnosis of a morellavallee lesion.
This lesion is more common on the thigh and trauma is the most frequent cause. We describe the diagnosis of such a lesion through the use of ultrasound imaging in the emergency department to utilize a fast, costeffective imaging technique that does not subject. Delayed presentation of a chronic morellavallee lesion. The morel lavallee lesion mll is a closed degloving injury most commonly described in the region of the hip joint after blunt trauma.
Surgeons often need to combine defatting of the avulsed skin with. Morellavallee lesion of the knee in a recreational frisbee. There is anechoic lesion in subcutaneous plane of proximal thigh on lateral aspect. Many cases of mll are missed at the initial evaluation, and the treatment of mll is not well established. The importance of morel lavallee lesion in medicolegal evaluation. Morellavallee lesion mll is a closed degloving injury resulting from blunt shearing or tangential forces.
Traumatic swellingeffusion in the knee region is a relatively common presenting complaint among athletes and nonathletes. It is characterized by a filled cystic cavity created by separation of the subcutaneous tissue from the underlying fascia. 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. One treatment option is the placement of a surgical drain after the lesion has been drained regardless of what technique is used. The percentage of patients who had aspiration of more than 50 ml of fluid was higher for lesions that recurred than for lesions that resolved 83% vs. A morel lavallee lesion is a posttraumatic soft tissue degloving injury. Morellavallee lesion haematoma or seroma occurs after close blunt trauma, direct or tangential, with a degloving mechanism that separates the hypodermis from the fascia beneath, causing a shearing injury. Morellavallee seroma posttraumatic pseudocyst of back. Nickerson tp, zielinski md, jenkins dh, schiller hj 2014 the mayo clinic experience with morel lavallee lesions.
Within this space, blood, serous fluid, and other materials may become trapped. Morel lavallee lesion mll occurs when there is a collection of haemolymph due to the separation of skin and subcutaneous tissue from the underlying fascia. Open access case report doxycycline as sclerotherapy for. This report outlines a case study of a unique presentation of a morel lavalle injury. We present two cases that demonstrate a previously unrecognised association of the mll with thoracolumbar spine fractures. I recommend adopting this algorithm to provide a standard pathway for dealing with it. On ultrasound the echogenicity, internal septations, hyperechoic fat globules. Morellavallee lesion initially diagnosed as quadriceps. Apr 09, 2015 morel lavallee lesion sonography with extended field of view along the long axis of the lesion shows fusiform shape and anechoic texture.
The third morellavallee lesion was superficial to the erector spinae muscles. If your lesion is small and not symptomatic, it may not need to be treated at all. Separation of soft tissues creating pocket of hemolymphatic fluid around right greater. Morellavallee lesions are posttraumatic soft tissue closed degloving injuries in which the subcutaneous tissue is torn away from the underlying fascia, creating a cavity filled with hematoma and liquefied fat. Morellavallee lesion is a closed degloving soft tissue injury in which the subcutaneous tissue is sheared off the fascia. In this condition, hemolymph is collected in the closed space between the separated subcutaneous tissue and the underlying fascia. This usually happens after blunt trauma and patients present with progressive swelling and pain. A 66yearold man was referred to the orthopedic clinic with swelling over the upper and outer aspect of the right thigh and trochanteric region following blunt trauma 25 years back. Due to its inconsistent clinical manifestations and. Morel lavallee lesion, haemolymph, ultrasound, magnetic resonance imaging abstract article history. Both collections above extend along the entire lateral aspect of the bilateral gluteus maximus.
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