The Mayo Clinic experience with Morel-Lavallée lesions: establishment of a practice management guideline.
BACKGROUND
Although uncommon, Morel-Lavallée lesions (also called closed degloving injuries) are associated with considerable morbidity in trauma patients. There is lack of consensus regarding proper management of these lesions. Management options include nonoperative therapies, along with percutaneous and operative techniques. We sought to define the factors associated with failure of percutaneous aspiration to better identify patients requiring immediate operative management.


METHODS
We retrospectively searched our prospectively collected database for patient records containing the terms Morel-Lavallée, closed degloving injury, or posttraumatic seroma from February 2, 2004, through December 23, 2011. Treatment methods included compression wraps or observation (nonoperative management), percutaneous aspiration, or operative management with incision/drainage or formal debridement of skin and soft tissues that resulted in wound vacuum-assisted closure placement and/or split-thickness skin graft (operative management). The treatment groups were compared using univariate analysis and χ testing.


RESULTS
We identified 79 patients with 87 Morel-Lavallée lesions in the setting of trauma. Most were caused by motor vehicle collisions (25%). No difference was observed between the treatment groups in sex, body mass index, anticoagulation treatment, diabetes mellitus, smoking history, or alcohol use. The percutaneous aspiration group had higher rates of recurrence (56% vs. 19% and 15% in nonoperative and operative groups, respectively). The percentage of patients who had aspiration of more than 50 mL of fluid was higher for lesions that recurred than for lesions that resolved (83% vs. 33%, p = 0.02).


CONCLUSIONS
Aspiration of more than 50 mL of fluid from Morel-Lavallée lesions was much more common among lesions that recurred (83%) than among those that resolved (33%). We therefore recommend that aspiration of more than 50 mL of fluid from a Morel-Lavallée lesion prompts operative intervention. We have now adopted this as a practice management guideline.


METHODS
Therapeutic/care management study, level III.
From the Division of Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester, Minnesota.
Terry P
TP
Nickerson
Martin D
MD
Zielinski
Donald H
DH
Jenkins
Henry J
HJ
Schiller
D000046:Academic Medical Centers; D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016208:Databases, Factual; D004322:Drainage / Q000379:methods*; D005260:Female; D006406:Hematoma / Q000209:etiology / Q000401:mortality / Q000628:therapy; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D035583:Rare Diseases; D012189:Retrospective Studies; D018570:Risk Assessment; D049291:Seroma / Q000209:etiology / Q000401:mortality / Q000628:therapy; D017695:Soft Tissue Injuries / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013577:Syndrome; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000175:diagnosis; D055815:Young Adult