Percutaneous management of more-lavallee lesions

Background: Previous recommendations for treatment of Morel-Lavallee soft-tissue degloving lesions have included open debridement 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: Nineteen patients with a Morel-Lavallee lesion were managed with percutaneous drainage and debridement of the lesion within three days after the injury. Drainage was usually completed through two 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 debride the injured fatty tissue, which was washed from the wound with pulsed lavage. A medium Hemo-vac drain was placed within the lesion and was removed when drainage was <30 mL over twenty-four hours. Results: Fifteen of the nineteen patients had surgery for an associated pelvic or acetabular fracture. Seven of the nine 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 two pelvic fractures and the six acetabular fractures was deferred until at least twenty-four hours after the drain was removed. Three of sixteen 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 debridement of skin and, at a minimum of six months, no deep infection had occurred. Conclusions: Early percutaneous drainage with debridement, 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. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.