Background: Previous recommendations for treatment of Morel-Lavallee
soft-tissue degloving lesions have included open débridement 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 débridement 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
débride the injured fatty tissue, which was washed from the wound with
pulsed lavage. A medium Hemovac 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
débridement of skin and, at a minimum of six months, no deep infection
Conclusions: Early percutaneous drainage with débridement,
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.