Clinical Presentation and Management of Pelvic Morel-Lavallee Injury in Obese Patients

Overview

Journal J Emerg Trauma Shock

Specialty Emergency Medicine

Date 2019 May 7

PMID 31057283

Citations 3

Authors

Mohammed Muneer

Ayman El-Menyar

Husham Abdelrahman

Musab Ahmed Murad

Sara M Al Harami

Ahmed Mokhtar

Mahwish Khawar

Ahmed Awad

Mohammad Asim

Rifat Latifi

Hassan Al-Thani

Affiliations

Soon will be listed here.

Abstract

Introduction: Morel-Lavallee lesion (MLL) is an infrequent or underreported serious consequence of closed degloving injuries. We aimed to describe the clinical presentation and management of pelvic MLL in obese patients.

Materials And Methods: A retrospective analysis was conducted for pelvic trauma patients with a diagnosis of MLL between 2010 and 2012. Patients' demographics, presentations, management, and outcomes were analyzed and compared based on the body mass index (BMI) and injury severity.

Results: Of 580 patients with pelvic region injuries, 183 (31.5%) had MLL with a mean age of 30.1 ± 12.2 years. The majority (75.4%) of MLL patients had a BMI ≥30 and 44% patients had pelvic fracture. Based on the initial clinical examination, MLL was diagnosed in 84% of patients and clinically missed in 16% of patients. Nonoperative management (NOM) was performed in 93.4% of patients, while primary surgical intervention was indicated in 6.6% of patients. Failed NOM was observed in seven cases, of them five were obese. The overall mortality in MLL patients was 12.6% and the frequency of deaths was nonsignificantly higher in Grade I obese patients. Multivariate analysis showed that injury severity score (odds ratio [OR]: 1.25, 95% confidence interval [CI]: 1.05-1.50) and Glasgow coma scale (OR: 0.72, 95% CI: 0.56-0.92) were the predictors of mortality in patients with MLL irrespective of BMI.

Conclusions: One-third of pelvic region injuries have MLL and three-quarter of them are obese. This significant association of obesity and MLL needs further prospective evaluation.

Citing Articles

[Application of channel screw combined with skin-stretching technique in treatment of pelvic fracture with severe Morel-Lavallée lesion].

Huang W, Luo Y, Yang E Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021; 35(8):973-977.

PMID: 34387424 PMC: 8403993. DOI: 10.7507/1002-1892.202103111.

The First Reported Case of Morel-Lavallée Lesion and Traumatic Abdominal Wall Hernia: A Case Report and Review of the Literature.

Shaban Y, Elkbuli A, Ovakimyan V, Hai S, Mckenney M, Boneva D Am J Case Rep. 2019; 20:1492-1496.

PMID: 31597909 PMC: 6796193. DOI: 10.12659/AJCR.918223.

Medico-legal considerations for Morel-Lavallée lesions.

Scanvion Q, Le Garff E, Gosset D, Hedouin V, Mesli V Forensic Sci Med Pathol. 2019; 15(4):612-615.

PMID: 31446612 DOI: 10.1007/s12024-019-00148-9.

References

Boulanger B, Milzman D, Mitchell K, Rodriguez A . Body habitus as a predictor of injury pattern after blunt trauma. J Trauma. 1992; 33(2):228-32. DOI: 10.1097/00005373-199208000-00011. View

Hudson D, Knottenbelt J, Krige J . Closed degloving injuries: results following conservative surgery. Plast Reconstr Surg. 1992; 89(5):853-5. DOI: 10.1097/00006534-199205000-00013. View

Harma A, Inan M, Ertem K . [The Morel-Lavallée lesion: a conservative approach to closed degloving injuries]. Acta Orthop Traumatol Turc. 2004; 38(4):270-3. View

Gilbert B, Bui-Mansfield L, Dejong S . MRI of a Morel-Lavellée lesion. AJR Am J Roentgenol. 2005; 182(5):1347-8. DOI: 10.2214/ajr.182.5.1821347. View

Kothe M, Lein T, Weber A, Bonnaire F . [Morel-Lavallée lesion. A grave soft tissue injury]. Unfallchirurg. 2005; 109(1):82-6. DOI: 10.1007/s00113-005-0984-2. View

Mukherjee K, Perrin S, Hughes P . Morel-Lavallee lesion in an adolescent with ultrasound and MRI correlation. Skeletal Radiol. 2006; 36 Suppl 1:S43-5. DOI: 10.1007/s00256-006-0122-4. View

Carlson D, Simmons J, Sando W, Weber T, Clements B . Morel-lavalée lesions treated with debridement and meticulous dead space closure: surgical technique. J Orthop Trauma. 2007; 21(2):140-4. DOI: 10.1097/BOT.0b013e31802f19ca. View

Tejwani S, Cohen S, Bradley J . Management of Morel-Lavallee lesion of the knee: twenty-seven cases in the national football league. Am J Sports Med. 2007; 35(7):1162-7. DOI: 10.1177/0363546507299448. View

Suzuki T, Morgan S, Smith W, Stahel P, Gillani S, Hak D . Postoperative surgical site infection following acetabular fracture fixation. Injury. 2009; 41(4):396-9. DOI: 10.1016/j.injury.2009.11.005. View

10.

Arnez Z, Khan U, Tyler M . Classification of soft-tissue degloving in limb trauma. J Plast Reconstr Aesthet Surg. 2010; 63(11):1865-9. DOI: 10.1016/j.bjps.2009.11.029. View

11.

Sawkar A, Swischuk L, Jadhav S . Morel-Lavallee seroma: a review of two cases in the lumbar region in the adolescent. Emerg Radiol. 2011; 18(6):495-8. DOI: 10.1007/s10140-011-0975-2. View

12.

Vanhegan I, Dala-Ali B, Verhelst L, Mallucci P, Haddad F . The morel-lavallée lesion as a rare differential diagnosis for recalcitrant bursitis of the knee: case report and literature review. Case Rep Orthop. 2013; 2012:593193. PMC: 3539348. DOI: 10.1155/2012/593193. View

13.

Shen C, Peng J, Chen X . Efficacy of treatment in peri-pelvic Morel-Lavallee lesion: a systematic review of the literature. Arch Orthop Trauma Surg. 2013; 133(5):635-40. DOI: 10.1007/s00402-013-1703-z. View

14.

Yilmaz A, Yener O . Giant post-traumatic cyst after motorcycle injury: a case report with review of the pathogenesis. Prague Med Rep. 2013; 114(2):123-7. DOI: 10.14712/23362936.2014.30. View

15.

Bonilla-Yoon I, Masih S, Patel D, White E, Levine B, Chow K . The Morel-Lavallée lesion: pathophysiology, clinical presentation, imaging features, and treatment options. Emerg Radiol. 2013; 21(1):35-43. DOI: 10.1007/s10140-013-1151-7. View

16.

Rha E, Kim D, Kwon H, Jung S . Morel-lavallee lesion in children. World J Emerg Surg. 2014; 8(1):60. PMC: 3892006. DOI: 10.1186/1749-7922-8-60. View

17.

Nickerson T, Zielinski M, Jenkins D, Schiller H . The Mayo Clinic experience with Morel-Lavallée lesions: establishment of a practice management guideline. J Trauma Acute Care Surg. 2014; 76(2):493-7. DOI: 10.1097/TA.0000000000000111. View

18.

Li H, Zhang F, Lei G . Morel-Lavallee lesion. Chin Med J (Engl). 2014; 127(7):1351-6. View

19.

Asim M, El-Menyar A, Al-Thani H, Abdelrahman H, Zarour A, Latifi R . Blunt traumatic injury in the Arab Middle Eastern populations. J Emerg Trauma Shock. 2014; 7(2):88-96. PMC: 4013743. DOI: 10.4103/0974-2700.130878. View

20.

Nair A, Nazar P, Sekhar R, Ramachandran P, Moorthy S . Morel-Lavallée lesion: A closed degloving injury that requires real attention. Indian J Radiol Imaging. 2014; 24(3):288-90. PMC: 4126145. DOI: 10.4103/0971-3026.137053. View