An unusual presentation of morel- lavallee lesion in the arm: a case report

<p class="abstract">Morel-lavallee lesions (MLL) are post traumatic closed internal de-gloving injury with abrupt separation of skin and subcutaneous tissue from the underlying fascia. The shearing force damages the blood vessels and lymphatics, resulting in collection of the serosanguinous fluid and necrotized fat. Early diagnosis and management minimize complications like infections or extensive skin necrosis. MLLs commonly described in pelvic and lower extremity trauma, and there are limited reports in other locations. A 28-year-old male presented with pain and swelling over the left elbow for 6 days with multiple deep bruises over the skin extending from mid arm to proximal forearm. Ultrasound of the arm revealed a large encapsulated collection consistent with MLL. An open debridement with excision of all necrotic skin and necrotic tissue was performed followed by skin grafting. Intra-operative cultures were negative and pathology was consistent with MLL. Morel-lavallee lesions should always be considered as early diagnosis of previous trauma regardless the location. The key to recognize this injury depends on suspicious mechanism involving significant shear forces. Aggressive surgical debridement remains the key to prevent significant morbidity and mortality.</p>

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Morel-Lavallee Lesion in the Upper Extremity

Hand ◽

10.1177/1558944716646776 ◽

2016 ◽

Vol 12 (1) ◽

pp. NP10-NP13 ◽

Cited By ~ 1

Author(s):

Grant K. Cochran ◽

Kathryn H. Hanna

Keyword(s):

Subcutaneous Tissue ◽

Care Physician ◽

Open Approach ◽

Acceptable Result ◽

Tissue Mass ◽

Degloving Injury ◽

Extremity Trauma ◽

Previous Trauma ◽

Prior Trauma ◽

Open Debridement

Background: The Morel-Lavallee lesion (MLL) is a closed internal degloving injury that results from shearing of the skin and subcutaneous tissue from the underlying fascia. Disruption of the perforating blood vessels and lymphatics results in a lesion filled with serosanguinous fluid and necrotized fat. MLLs are most commonly described in association with pelvic and lower extremity trauma, and there are limited reports of these lesions in other locations. Methods: This case report describes a 58-year-old male referred from his primary care physician with a soft tissue mass in the upper arm. Careful history discovered prior trauma with extensive bruising and MRI revealed a large encapsulated mass consistent with MLL. Results: An open debridement with excision of pseudocapsule was performed. Meticulous closure over a drain was performed and the patient healed without complication or recurrence. Intra-operative cultures were negative and pathology was consistent with MLL. Conclusion: MLL should always be considered in the setting of previous trauma regardless the location. In the chronic setting an open approach with excision of pseudocapsule can have an acceptable result.

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Management of recurrent post-traumatic seroma of thigh (Morel-Lavallée lesion) by percutaneous aspiration and sclerotherapy using tetracyclines (PAST)

BMJ Case Reports ◽

10.1136/bcr-2020-238804 ◽

2021 ◽

Vol 14 (1) ◽

pp. e238804

Author(s):

Arunesh Gupta ◽

Vineet Kumar ◽

Apurva Agarwal ◽

Aneesh Suresh

Keyword(s):

Early Diagnosis ◽

Conservative Management ◽

Bacterial Contamination ◽

Soft Tissues ◽

Successful Outcome ◽

Serous Fluid ◽

Percutaneous Aspiration ◽

Post Traumatic ◽

Open Debridement ◽

Definitive Management

Morel-Lavallée lesion is a chronic, recurrent collection of serous fluid in the soft tissues and usually occurs following injury. The most common sites are thigh, hip and pelvic region. This presents as a local or diffuse swelling and may cause discomfort to the patient besides being a potential site for bacterial contamination. So, early diagnosis and timely management is crucial for an early and successful outcome. The investigation modality of choice for diagnosis of these lesions is MRI. Definitive management ranges from percutaneous aspiration with or without sclerotherapy to open debridement and irrigation. Although recurrences are common with conservative management, it can be minimised with judicious use of sclerotherapy.

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The Insensate Foot Following Severe Lower Extremity Trauma: An Indication for Amputation?

Yearbook of Orthopedics ◽

10.1016/s0276-1092(08)70396-1 ◽

2006 ◽

Vol 2006 ◽

pp. 95-97

Author(s):

M.F. Swiontkowski

Keyword(s):

Lower Extremity ◽

Lower Extremity Trauma ◽

Extremity Trauma

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Infectious Complications and Soft Tissue Injury Contribute to Late Amputation After Severe Lower Extremity Trauma

Yearbook of Critical Care Medicine ◽

10.1016/j.yccm.2011.10.003 ◽

2012 ◽

Vol 2012 ◽

pp. 132-133

Author(s):

D.J. Dries

Keyword(s):

Soft Tissue ◽

Lower Extremity ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Infectious Complications ◽

Lower Extremity Trauma ◽

Extremity Trauma

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NECROTISING SOFT TISSUE INFECTION OF BILATERAL UPPER LIMB CAUSED BY THE INJECTION OF ORAL BACTERIA: A CASE REPORT

Hand Surgery ◽

10.1142/s021881041372012x ◽

2013 ◽

Vol 18 (02) ◽

pp. 243-246 ◽

Cited By ~ 1

Author(s):

Yuichi Yoshii ◽

Tomoo Ishii ◽

Shinsuke Sakai

Keyword(s):

Soft Tissue ◽

Upper Limb ◽

Soft Tissue Infection ◽

Soft Tissues ◽

Biceps Brachii ◽

Subcutaneous Tissue ◽

Oral Bacteria ◽

Tissue Infection ◽

Left Elbow ◽

The Right

Necrotising soft tissue infection is a rare and rapid process with devastating consequence. We report one case of necrotising soft tissue infection in a bilateral upper limb with uncommon oral bacteria. Radiological imaging revealed the presence of gas in upper limb soft tissues, and an MRI showed the localised signal changes in the biceps muscle of the right upper arm, and the subcutaneous tissue of the left elbow. The patient was treated with surgical resection of the infected muscle and wide debridement of the subcutaneous tissue. Antibiotics were initiated. The patient recovered immediately without functional deficit. The unique features of this patient were possible to observe in the progression of the necrotising soft tissue infection in the bilateral upper limb with intentional injection of oral bacteria, and the effect of biceps brachii resection in a prime age worker.

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Post-traumatic pseudolipoma of the forehead

Canadian Journal of Plastic Surgery ◽

10.1177/229255030701500312 ◽

2007 ◽

Vol 15 (3) ◽

pp. 173-174 ◽

Cited By ~ 1

Author(s):

David Horovitz ◽

Damir B Matic

Keyword(s):

Subcutaneous Tissue ◽

Clinical Findings ◽

Frontal Bone ◽

Forceps Delivery ◽

Resonance Imaging ◽

Frontalis Muscle ◽

Rare Finding ◽

History Of ◽

Post Traumatic ◽

Fibrofatty Tissue

A forehead lipoma is a rare finding in a child, and one that penetrates the underlying layers of muscle and bone to attach to dura has not previously been reported. Two such cases, both in children who underwent uneventful deliveries aided by forceps, are presented. Both lesions were present at birth and, based on clinical findings, were originally thought to be dermoid cysts. Dermoid cysts could not be ruled out with computed tomography and magnetic resonance imaging. Histopathology identified fibrofatty tissue consistent with lipoma. Both lesions extended from the subcutaneous tissue through the frontalis muscle and frontal bone to the dura. Given these findings and the history of forceps delivery, the most likely diagnosis is posttraumatic pseudolipoma. This lesion should be considered in the differential diagnosis of congenital lesions of the forehead, particularly if there is a history of forceps delivery or other trauma to the area.

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