The Morel-Lavallée lesion revisited: management in spinopelvic dissociation

• Published in: The spine journal 2015-06, Vol.15 (6), p.e45-e51
• Main Authors: Dodwad, Shah Nawaz M., MD, Niedermeier, Steven R., MS, Yu, Elizabeth, MD, Ferguson, Tania A., MD, Klineberg, Eric O., MD, Khan, Safdar N., MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Debridement; Disease Management; Drainage; Female; Humans; Infection; Male; Middle Aged; Morel-Lavallée lesion; Orthopedics; Pelvis - diagnostic imaging; Pelvis - injuries; Pelvis - surgery; Radiography; Retrospective Studies; Seroma - diagnostic imaging; Seroma - surgery; Soft Tissue Injuries - diagnostic imaging; Soft Tissue Injuries - surgery; Spinal Injuries - diagnostic imaging; Spinal Injuries - surgery; Spine trauma; Spinopelvic disassociation; Treatment Outcome
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2013.08.023

Abstract Background context The Morel-Lavallée lesion occurs from a compression and shear force that usually separates the skin and subcutaneous tissue from the underlying muscular fascia. A dead space is created that becomes filled with blood, liquefied fat, and lymphatic fluid from the shearing of vasculature and lymphatics. If not treated appropriately, these lesions can become infected, cause tissue necrosis, or form chronic seromas. Purpose To review appropriate identification and treatment of Morel-Lavallée lesions in spinopelvic dissociation patients. Study design Uncontrolled case series. Methods Retrospective review of medical records. No funding was received in support of this study. The authors report no conflicts of interest. Results We present four cases of patients with traumatic spinopelvic dissociation. All had concomitant lumbosacral Morel-Lavallée lesions. All four trauma patients suffered traumatic spinopelvic dissociation with concomitant lumbosacral Morel-Lavallée lesions. Appropriate treatment included irrigation and debridement, drainage, antibiotics, and vacuum-assisted wound closure. Conclusions Our series reflects an association of Morel-Lavallée lesion in spinopelvic dissociation trauma patients. Possibly, the rotatory injury that occurs at the spinopelvic junction creates a shear force to form the Morel-Lavallée lesion. When presented with a spinopelvic dissociation patient, one should be prepared to treat a Morel-Lavallée lesion.