Morel-Lavallée lesion of the anterior leg: a rare anatomical presentation

A Morel-Lavallée lesion (MLL) is a rare injury caused by blunt force trauma causing separation of subcutaneous tissue from the deep fascia. It is frequently seen in orthopaedic cases involving fractures of the hip or pelvis but is rare in the lower leg. The rarity of this condition often leads to mi...

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Bibliographic Details
Published in:BMJ case reports 2020-02, Vol.13 (2), p.e233295
Main Authors: Ramaseshan, Karthik, Bauler, Laura D, Mastenbrook, Joshua
Format: Article
Language:English
Subjects:
Aged
Antibiotics
Case reports
Contusions
Degloving Injuries - classification
Degloving Injuries - diagnosis
Diagnostic Errors
Ecchymosis - complications
Edema
Edema - complications
emergency medicine
Erythema - complications
Fractures
general surgery
Humans
Injuries
Leg Injuries - classification
Leg Injuries - diagnosis
Literature reviews
Magnetic Resonance Imaging
Male
Medical diagnosis
Necrosis
Pain
Patients
Primary care
Skin
Subcutaneous Tissue - pathology
Trauma
Ultrasonic imaging
Ultrasonography, Doppler
Unusual Presentation of More Common Disease/Injury
X-Rays
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Summary:A Morel-Lavallée lesion (MLL) is a rare injury caused by blunt force trauma causing separation of subcutaneous tissue from the deep fascia. It is frequently seen in orthopaedic cases involving fractures of the hip or pelvis but is rare in the lower leg. The rarity of this condition often leads to misdiagnosis. A 66-year-old man presented to the emergency department after a 300-pound safe sheered across his left anterolateral leg causing skin avulsion, tenderness, swelling, ecchymosis, and erythema. The patient was treated for suspected cellulitis with oral antibiotics, but the lesion evolved into a necrotic eschar necessitating surgical intervention. In hindsight, MLL is a more appropriate diagnosis based on injury mechanism, disease progression and intraoperative findings. A history of shearing trauma with diffuse ecchymosis and erythema should prompt consideration of MLL. Due to rampant misdiagnosis, this case aims to increase awareness, as early diagnosis of MLL will improve patient outcomes.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2019-233295