A Novel Surgical Technique for treatment of Morel-Lavallée Lesion: Endoscopic debridement combined with percutaneous cutaneo-fascial suture

Abstract

Morel-Lavallée lesions are rare, closed degloving soft tissue injuries in which the skin and subcutaneous tissues are traumatic separated from the underlying fascia. There is lack of consensus regarding optimal management of these lesions. After failure of conservative management, operative intervention is imperative. The purpose of this manuscript is to describe a minimally invasive endoscopic method for treatment of Morel-Lavallée Lesions, which achieves the goal of an open surgical debridement.

Introduction

Although uncommon, Morel-Lavallée lesions (MLL) are challenging posttraumatic closed soft-tissue injuries in which subcutaneous soft tissues are separated from the deep fascia creating a potential space that can be filled with serosanguinous fluid, blood and necrotic fat [1]. Various methods have been described for the treatment of Morel-Lavallée Lesions, including compression dressings, needle aspiration, injection of sclerosing agents, deep fascial fenestration, percutaneous surgical drainage [[2], [3], [4], [5], [6], [7], [8], [9]]. These methods, however, do not remove the necrotic fibrotic adipose tissue and close the potential space, whereby prolonged symptoms or recrudescence could ensue, especially for those large lesions and chronic lesions [[10], [11], [12]]. Open drainage and surgical debridement are the most radical treatment [13]. However, it is too aggressive and not practical for patients who hope to have a speedy recovery. Moreover, lesions with skin necrosis often require excision and skin grafting [2,11]. To our knowledge, the appropriate treatment algorithm for MLL remains elusive.

In this paper, we describe a simple and effective technique, endoscopic debridement combined with percutaneous cutaneo-fascial suture. It could provide a minimally invasive alternative for the treatment of Morel-Lavallée Lesions.