title: Management of Morel-Lavallee Lesion Associated with Pelvic and/or Acetabular Fractures.
abstract: OBJECTIVE
  Management of Morel-Lavallee soft tissue lesion (MLL) in patients with associated pelvic and/or acetabular fractures is still under discussion. Especially, the sequence of treatment of MLL soft tissue management and osteosynthesis of pelvic and acetabular injury remains controversial.
  
  
  METHODS
  We report all consecutive patients with MLL associated with pelvic ring and/or acetabular fractures during an 8-year period at our hospital. Surgical access and techniques were analyzed concerning complications and outcome.
  
  
  RESULTS
  Altogether, 20 patients were included in the study. One patient was treated conservatively and MLL healed without complications; 19 patients had an operative treatment of MLL. In 15 patients debridement was performed within one day after injury and in four patients with delay of 5 days at least. Ten patients had surgery for an associated pelvic ring or acetabular fracture. In four of them MLL was operated before, in six patients simultaneously to osteosynthesis. In three patients, the same surgical approach for osteosynthesis and debridement of MLL was used; none of them showed postoperative complications. Altogether, in nine operated patients (47.4%) MLL healed without any complications. Nine operated patients presented prolonged wound healing, however, during long term follow-up, all patients showed complete healing of the MLL. One patient died during resuscitive surgical procedures.
  
  
  CONCLUSIONS
  We recommend debridement for early and delayed treatment of MLL. Osteosynthesis during first debridement may be performed without adverse outcome. Identical surgical access for both procedures can be used. In case of repeated surgical debridement VAC(®) therapy may be a helpful tool for dead space reduction and wound conditioning.
authors.affiliation: Division of Trauma Surgery, University Hospital, Rämistrasse 100, 8091, Zürich, Switzerland. christian.steiner@usz.ch.
authors.forename: Christian Luzius
authors.initials: CL
authors.lastname: Steiner
authors.forename: Otmar
authors.initials: O
authors.lastname: Trentz
authors.affiliation: Division of Trauma Surgery, Department of Surgery, University Hospital, Zürich, Switzerland.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Labler
keywords: Hip fracture; Pelvic and acetabular fractures; Pelvis; Soft tissue injuries and infection; Wound healing
references.citation: Ann Plast Surg. 1997 Jun;38(6):563-76; discussion 577
references.pmid: 9188971
references.citation: Skeletal Radiol. 1997 Apr;26(4):239-41
references.pmid: 9151373
references.citation: Clin Orthop Relat Res. 1996 Aug;(329):46-53
references.pmid: 8769435
references.citation: J Trauma. 1990 Nov;30(11):1356-65
references.pmid: 2231804
references.citation: J Trauma. 1993 Sep;35(3):375-82; discussion 382-3
references.pmid: 8371295
references.citation: Langenbecks Arch Surg. 2007 Sep;392(5):601-9
references.pmid: 16983575
references.citation: J Bone Joint Surg Am. 2006 Jan;88(1):92-6
references.pmid: 16391253
references.citation: Clin Orthop Relat Res. 1995 Sep;(318):61-74
references.pmid: 7671533
references.citation: Harefuah. 2006 Feb;145(2):111-3, 166
references.pmid: 16509414
references.citation: J Trauma. 1974 Mar;14(3):187-96
references.pmid: 4814394
references.citation: Plast Reconstr Surg. 1985 Mar;75(3):342-54
references.pmid: 3975284
references.citation: Acta Orthop Traumatol Turc. 2004;38(4):270-3
references.pmid: 15618769
references.citation: JAMA. 1971 Jan 11;215(2):277-80
references.pmid: 5107365
references.citation: JAMA. 1980 Mar 21;243(11):1156-9
references.pmid: 7359667
references.citation: J Trauma. 1997 Jun;42(6):1046-51
references.pmid: 9210539
references.citation: J Trauma. 1981 Oct;21(10):835-9
references.pmid: 7024564
references.citation: J Trauma. 1990 May;30(5):539-45; discussion 545-6
references.pmid: 2342136
references.citation: J Trauma. 2000 Nov;49(5):969-78
references.pmid: 11086798
references.citation: Plast Reconstr Surg. 1992 May;89(5):853-5
references.pmid: 1561257
references.citation: Ann Plast Surg. 1997 Jun;38(6):553-62
references.pmid: 9188970