From the Research
A Morel-Lavallee lesion without fracture or joint involvement is typically treated by general surgery rather than orthopedics. This closed degloving injury, characterized by separation of subcutaneous tissue from underlying fascia with resultant fluid collection, falls within general surgery's scope when it exists in isolation. Treatment generally involves drainage of the hematoma/seroma, which can be done through aspiration for smaller lesions or formal surgical drainage for larger or recurrent collections 1. Compression therapy is essential post-drainage to prevent reaccumulation of fluid. Some cases may require sclerodesis using agents like doxycycline or talc to prevent recurrence. For infected lesions, appropriate antibiotics are necessary alongside drainage. While orthopedics would manage these lesions when they accompany fractures or joint injuries, the isolated soft tissue nature of uncomplicated Morel-Lavallee lesions makes them appropriate for general surgical management. The decision may also depend on institutional practices and the specific anatomical location of the lesion, with some facilities having plastic surgery manage certain cases, particularly those requiring complex soft tissue reconstruction.
Key considerations in the management of Morel-Lavallee lesions include:
- Early diagnosis and treatment to prevent complications such as infection and chronic recurrence 2
- Use of imaging studies, such as MRI, to confirm the diagnosis and guide treatment 3
- Avoidance of conservative management, especially for chronic lesions, and consideration of percutaneous aspiration, sclerodesis, or open surgery as needed 3
- The importance of compression therapy and potential use of quilting sutures, curettage, and low suction drains as adjuncts in treatment 3
In terms of specific treatment algorithms, a study from 2018 recommends avoidance of conservative management and suggests that percutaneous aspiration should not be used in isolation for chronic lesions 3. Sclerodesis using doxycycline is proposed for lesions up to 400 ml, with larger lesions potentially requiring open surgery. These recommendations are based on a review of the literature and aim to provide a comprehensive overview of Morel-Lavallee lesions and their management. Overall, the treatment of Morel-Lavallee lesions without fracture or joint involvement should prioritize general surgical management, with consideration of the specific lesion characteristics and institutional practices.