Management of Morel-Lavallée Lesions
Plastic and reconstructive surgeons are the primary specialists who manage Morel-Lavallée lesions, particularly for complex or recurring cases, as the comprehensive skillset required for successful treatment—including open debridement, dead space closure techniques, negative pressure wound therapy, and skin grafting or flap reconstruction—falls squarely within their expertise. 1
Why Plastic Surgery?
Morel-Lavallée lesions are closed degloving injuries caused by shearing forces that create a space for hemolymphatic fluid collection between superficial soft tissues and fascial layers 1, 2. These lesions frequently require staged surgical interventions beyond simple drainage, making plastic surgeons the ideal specialists for definitive management 1.
The complexity of these lesions demands surgical expertise in:
- Open debridement of devitalized tissue 1
- Techniques to eliminate dead space (quilting sutures, curettage) 2
- Negative pressure wound therapy application 1
- Skin grafting or flap reconstruction for complex cases 1
When to Involve Plastic Surgery
For acute, uncomplicated lesions (<400 mL): Initial management may involve interventional radiology or orthopedic surgery for percutaneous drainage within 3 days of injury 3. However, plastic surgery consultation should be obtained early if the lesion is large or shows signs of complexity 1.
For chronic, recurrent, or complicated lesions: Direct referral to plastic surgery is appropriate, as these cases typically require open surgical intervention rather than percutaneous approaches alone 2.
For lesions associated with pelvic or acetabular fractures: Orthopedic surgeons often manage the initial trauma, but plastic surgery should be involved for the soft tissue component, particularly when surgical fixation is planned 3.
Other Specialists Involved
Interventional radiologists can perform initial percutaneous drainage and sclerotherapy with doxycycline for lesions up to 400 mL 4, 2. All patients should undergo ultrasonography for diagnosis, and radiologists need familiarity with this entity for image-guided treatment 4.
Orthopedic surgeons frequently encounter these lesions in polytrauma patients with pelvic or acetabular fractures and should actively look for them in this setting 5, 2. They may perform initial percutaneous management but should involve plastic surgery for definitive treatment 3.
Common Pitfalls
Delayed recognition: These lesions are prone to missed or delayed diagnosis, which increases infection risk, particularly when associated with fractures 5. MRI is the investigation of choice for diagnosis 2.
Inadequate initial treatment: Conservative management with compression bandaging alone should be avoided 2. For chronic lesions, percutaneous aspiration should not be used in isolation 2.
Underestimating complexity: Lesions exhibiting delayed healing, super-infection, or recurrence after initial treatment require the comprehensive surgical approach that plastic surgeons provide 1.