%0 Journal Article
%T Missed Massive Morel-Lavallee Lesion
%A Shunsuke Takahara
%A Keisuke Oe
%A Hironori Fujita
%A Atsushi Sakurai
%A Takashi Iwakura
%A Sang Yang Lee
%A Takahiro Niikura
%A Ryosuke Kuroda
%A Masahiro Kurosaka
%J Case Reports in Orthopedics
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/920317
%X A Morel-Lavallee lesion (MLL) involves posttraumatic fluid collection around the greater trochanter. Many cases of MLL are missed at the initial evaluation, and the treatment of MLL is not well established. We present two cases in which MLL was missed at the initial evaluation. Case 1. A 65-year-old man was run over by a parade float. There was subcutaneous hematoma around the left greater trochanter, and no fracture was found. We diagnosed this injury as MLL on the 7th day after the trauma. Although we performed percutaneous drainage, the injured area was infected. Case 2. A 57-year-old man was hit by a train in a factory. There was an iliac wing fracture, but an MLL was not initially recognized. On the 6th day after the trauma, when performing open reduction and internal fixation for the iliac fracture, we recognized the lesion and performed percutaneous drainage simultaneously. This lesion also became infected. In these two cases, the wounds finally healed after a long duration of treatment. We suggest that it is important to keep this injury in mind and debride the lesion early and completely in the treatment course. 1. Introduction Closed degloving injury is a severe traumatic separation between the skin and subcutaneous tissue underlying the fascia. Morel-Lavallee lesion (MLL) was first reported by the French physician Maurice Morel-Lavallee in 1853. It is a closed degloving injury occurring over the greater trochanter and is associated with pelvic trauma [1¨C7]. MLL also occurs around the lower lumbar area [8], calf [9], and knee [10, 11]. MLL typically appears as a fluid collection filled with serous fluid, blood, or necrotic fat [2¨C4]. Most reports of MLL have been associated with an increased risk of infection [2¨C15]; therefore, it is important to debride the lesion before it becomes infected. However, MLL tends to be missed, because the significance of the lesion may not be initially apparent [5]. Additionally, even when the lesion becomes apparent, the treatment of MLL remains controversial. We present two cases of MLL that required a long duration to heal because of misdiagnosis at the initial evaluation. We also review the literature and discuss the incidence, causes, and treatment of MLL. 2. Case Presentation Case£¿£¿1. A 65-year-old man with no underlying disease was run over by a parade float at a festival. Computed tomography (CT) showed a subcutaneous hematoma around the left greater trochanter with no evidence of fracture (Figure 1(a)). The fluctuation in this area gradually spread, and CT examination on the 7th day revealed that the
%U http://www.hindawi.com/journals/crior/2014/920317/