title: Simultaneous occurrence of a severe Morel-Lavallée lesion and gluteal muscle necrosis as a sequela of transcatheter angiographic embolization following pelvic fracture: a case report.
abstract: BACKGROUND
  Morel-Lavallée lesions are posttraumatic hemolymphatic collections caused by disruption of the interfascial planes between the subcutaneous soft tissue and muscle. Severe peripelvic Morel-Lavallée lesions have rarely been reported in the literature. By contrast, a number of cases of gluteal muscle necrosis following transcatheter angiographic embolization for pelvic fracture have been reported. Each entity can result in severe infection and sepsis, and the mortality rate in such cases is quite high. However, to date, no previous reports have described a case in which these life-threatening entities occurred simultaneously.
  
  
  METHODS
  A 32-year-old Asian man simultaneously developed severe peripelvic Morel-Lavallée lesions and gluteal muscle necrosis with sepsis following transcatheter angiographic embolization after an unstable pelvic fracture. Extremely large skin and soft tissue defects, which were untreatable with any commonly used flaps, were generated after repeated debridement. In addition, a deep-bone infection was suspected in his left fractured iliac bone, while motor function was almost completely lost in his left leg, possibly as a sequela of transcatheter angiographic embolization. As a result of his condition, a left hemipelvectomy was unavoidable. A pedicled fillet flap from his sacrificed left limb was used for the treatment of the defects and to provide a durable base for a prosthesis. Our patient survived and returned to his previous job 24 months after the surgery wearing a prosthetic left leg.
  
  
  CONCLUSIONS
  As illustrated by the present case, severe peripelvic Morel-Lavallée lesions and gluteal muscle necrosis following transcatheter angiographic embolization can occur simultaneously after unstable pelvic fractures. Physicians should recognize that these entities can result in life-threatening sepsis and, therefore, should attempt to detect them as early as possible. When hemipelvectomy is unavoidable, a pedicled upper and lower leg in-continuity fillet flap may provide satisfactory outcomes.
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Syogoin, Sakyo-ku, Kyoto, 606-8507, Japan. takayosh@kuhp.kyoto-u.ac.jp.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Shimizu
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Syogoin, Sakyo-ku, Kyoto, 606-8507, Japan. smat522@kuhp.kyoto-u.ac.jp.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Matsuda
authors.affiliation: Department of Orthopedic Surgery, Nagahama City Hospital, 313 Ouinuicho, Nagahama, Shiga, 526-0043, Japan. ragisaku@gmail.com.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sakuragi
authors.affiliation: Department of Plastic Surgery, Kitano Hospital, 2-4-20 Ougimachi, Kita-ku, Osaka city, Osaka, 530-8480, Japan. tsukie@i.softbank.jp.
authors.forename: Tomio
authors.initials: T
authors.lastname: Tsukie
authors.affiliation: Department of Orthopedic Surgery, Shiga Medical Center for Adults, 5-4-30 Moriyama, Moriyama city, Shiga, 524-8524, Japan. kawanabe@mdc.med.shiga-pref.jp.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kawanabe
mesh_terms: D000328:Adult; D000792:Angiography / Q000009:adverse effects*; D002081:Buttocks / Q000473:pathology; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D050723:Fractures, Bone / Q000601:surgery*; D006428:Hemipelvectomy / Q000009:adverse effects; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000473:pathology*; D009336:Necrosis / Q000209:etiology; D010384:Pelvic Bones / Q000293:injuries* / Q000601:surgery; D018805:Sepsis / Q000209:etiology; D013848:Thigh / Q000601:surgery