Tseng, J Bone Joint Surg Am 2006 - Percutaneous Management of Morel-Lavallee Lesions

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Percutaneous Management of Morel-Lavallee Lesions

Tseng, Tornetta·J Bone Joint Surg Am·2006·178 citations·Case series

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Background

Previous recommendations for treatment of Morel-Lavallee soft-tissue degloving lesions have included open débridement with packing or delayed closure. The purpose of this study was to review the use of percutaneous drainage for the initial management of these lesions.

Methods

19 patients with a Morel-Lavallee lesion were managed with percutaneous drainage and débridement of the lesion within 3 days after the injury.
Drainage was usually completed through 2 2-cm incisions: one over the distal aspect of the lesion and one over the most superior and posterior extent of the lesion.
A plastic brush was used to débride the injured fatty tissue, which was washed from the wound with pulsed lavage.
A medium Hemovac drain was placed within the lesion and was removed when drainage was <30 mL over 24 hours.

Results

15 of the 19 patients had surgery for an associated pelvic or acetabular fracture.
7 of the 9 patients in whom a pelvic fracture was treated surgically had percutaneous fixation of the posterior part of the pelvic ring as well as treatment of the Morel-Lavallee lesion during the same operative setting.
Fixation of the remaining 2 pelvic fractures and the 6 acetabular fractures was deferred until at least 24 hours after the drain was removed.
3 of 16 cultures of specimens taken from the wounds were positive.
None of the patients with percutaneous fixation of the pelvis had wound complications.
One wound required surgical exploration because of persistent drainage, but the culture was negative and the wound healed with no sequelae.
No patient required débridement of skin and, at a minimum of 6 months, no deep infection had occurred.

Conclusions

Early percutaneous drainage with débridement, irrigation, and suction drainage for the treatment of Morel-Lavallee lesions appears to be safe and effective. Percutaneous procedures for pelvic fixation were well tolerated by the small number of patients in this series, and open procedures appeared to be safe when performed in a delayed fashion.

Copyright remains with the authors and publisher.

Percutaneous Management of Morel-Lavallee Lesions.

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Percutaneous Management of Morel-Lavallee Lesions

Tseng, Tornetta·J Bone Joint Surg Am·2006·178 citations·Case series

|

Background

Previous recommendations for treatment of Morel-Lavallee soft-tissue degloving lesions have included open débridement with packing or delayed closure. The purpose of this study was to review the use of percutaneous drainage for the initial management of these lesions.

Methods

19 patients with a Morel-Lavallee lesion were managed with percutaneous drainage and débridement of the lesion within 3 days after the injury.
Drainage was usually completed through 2 2-cm incisions: one over the distal aspect of the lesion and one over the most superior and posterior extent of the lesion.
A plastic brush was used to débride the injured fatty tissue, which was washed from the wound with pulsed lavage.
A medium Hemovac drain was placed within the lesion and was removed when drainage was <30 mL over 24 hours.

Results

15 of the 19 patients had surgery for an associated pelvic or acetabular fracture.
7 of the 9 patients in whom a pelvic fracture was treated surgically had percutaneous fixation of the posterior part of the pelvic ring as well as treatment of the Morel-Lavallee lesion during the same operative setting.
Fixation of the remaining 2 pelvic fractures and the 6 acetabular fractures was deferred until at least 24 hours after the drain was removed.
3 of 16 cultures of specimens taken from the wounds were positive.
None of the patients with percutaneous fixation of the pelvis had wound complications.
One wound required surgical exploration because of persistent drainage, but the culture was negative and the wound healed with no sequelae.
No patient required débridement of skin and, at a minimum of 6 months, no deep infection had occurred.

Conclusions

Early percutaneous drainage with débridement, irrigation, and suction drainage for the treatment of Morel-Lavallee lesions appears to be safe and effective. Percutaneous procedures for pelvic fixation were well tolerated by the small number of patients in this series, and open procedures appeared to be safe when performed in a delayed fashion.

Copyright remains with the authors and publisher.

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