Morel Lavallée Lesion – A Case Report
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• Morel Lavallée Lesion is an elusive diagnosis & can cause a life-threatening state

• Diagnosis of Morel Lavallée Lesion is clinical, but aided by several modalities

• There are several treatment options for Morel Lavallée Lesion. Morel Lavallée Lesion should be treated when diagnosed

Morel- Lavallée lesion (MLL) is an uncommon entity, by which shearing forces result in a closed degloving lesion. This can result in an infected hematoma and lead to a life-threatening situation. A 59 years-old male, was injured in his right thigh as a result of a crushing injury during his work as a fisherman. The thigh was crushed between his ship and a rope for 15 minutes. The fracture was ruled out In the emergency department (ED) an abrasion was noted. Vascular investigation showed patent vessels. X-ray imaging showed no fracture. In computed tomography (CT) there was significant sub-dermal edema, with fat opacity. The patient was hospitalized for 5 days. Upon his discharge, a dry superficial necrotic skin area was noted, with no fluctuation or infection.

One week after discharge, during a routine follow-up, the patent mentioned a fever 2 days prior to the follow-up. He was treated with Augmentin (amoxicillin-clavulanic acid) 875 mg BID. In his exam, there was mild cellulitis noted. One week later, during the second follow-up, a 3rd year resident physician from our department was called to consult. An area of skin necrosis, roughly 10*15 cm, was noted. The was significant swelling and fluctuation. The patient rushed to ED, where drainage took place. Approximately 3 L of blood, necrotic muscles, and skin were drained. The patient was hospitalized.

Due to cultures showing S.aureus and P.aeruginosa the treatment was changed to Ciprofloxacin and Cefazoline. The patient underwent 2 split thickness skin grafts. The first graft failed due to a different P.aeruginosa found in the wound bed. The second graft succeeded and the patient was discharged to his home. During follow-up in the outpatient clinic, the patient was dressed with Aquacel® AG bandage until fully healed. Signs of hypertrophic scar were noted, and the patient was referred to a physical therapist for silicone dressing.