phadke_ajit at hotmail
Oct 24, 2006, 10:53 AM
Post #5 of 5
Dear Dr. Eid
Before reading about the closed suction , I have treated 2 such patients by incision. the problem is that unless the two dissected layers stick together, it continues to drain. What you will have to do now is Scrape the whole cavity under GA to create rawq surfaces. Then place a Suction drain in the cavity. and close the whole incision. Tie a elastic pressure bandage-- spica like -- and keep the drain in till it stops draining. It took 8 days in one patient of mine. You have to give prophylactic antbiotics to prevent the whole thing getting infected. Its a messy business but it works. Best of luck
----- Original Message -----
From: Dr Eid
Sent: Tuesday, October 24, 2006 12:21 AM
Subject: Re: Morel Lavallee lesion
Dear Dr Margic
Thank you for your response. The problem , however, is that I did incise through the lesion because I was initially unaware of it. So percutaneous closed treatment is not an option now. My query is about open treatment, and if anybody on the list has actually met with and managed such lesions.
Dr Abdelsalam EID M.D., AFSA (Paris V)
Lecturer of Orthopedic Surgery
Faculty of Medicine, Zagazig University,
----- Original Message ----
From: Krunoslav Margić <Krunoslav.Margic@guest.arnes.si>
Sent: Sunday, October 22, 2006 11:34:32 PM
Subject: Re: Morel Lavallee lesion
Decollement traumatique, closed degloving injury, avulsio traumatica subcutis, Morel-Lavallee lesion:
Susan Tseng, and Paul Tornetta, III..Percutaneous Management of Morel-Lavallee Lesions.The Journal of Bone and Joint Surgery (American). 2006;88:92-96.
Background: Previous recommendations for treatment of Morel-Lavallee soft-tissue degloving lesions have included open débridement with packing or delayed closure. The purpose of this study was to review the use of percutaneous drainage for the initial management of these lesions.
Methods: Nineteen patients with a Morel-Lavallee lesion were managed with percutaneous drainage and débridement of the lesion within three days after the injury. Drainage was usually completed through two 2-cm incisions: one over the distal aspect of the lesion and one over the most superior and posterior extent of the lesion. A plastic brush was used to débride the injured fatty tissue, which was washed from the wound with pulsed lavage. A medium Hemovac drain was placed within the lesion and was removed when drainage was <30 mL over twenty-four hours.
Results: Fifteen of the nineteen patients had surgery for an associated pelvic or acetabular fracture. Seven of the nine patients in whom a pelvic fracture was treated surgically had percutaneous fixation of the posterior part of the pelvic ring as well as treatment of the Morel-Lavallee lesion during the same operative setting. Fixation of the remaining two pelvic fractures and the six acetabular fractures was deferred until at least twenty-four hours after the drain was removed. Three of sixteen cultures of specimens taken from the wounds were positive. None of the patients with percutaneous fixation of the pelvis had wound complications. One wound required surgical exploration because of persistent drainage, but the culture was negative and the wound healed with no sequelae. No patient required débridement of skin and, at a minimum of six months, no deep infection had occurred.
Conclusions: Early percutaneous drainage with débridement, irrigation, and suction drainage for the treatment of Morel-Lavallee lesions appears to be safe and effective. Percutaneous procedures for pelvic fixation were well tolerated by the small number of patients in this series, and open procedures appeared to be safe when performed in a delayed fashion.
Prim.dr. Krunoslav Margic,dr.med
Department of Plastic and Reconstructive Surgery
Sempeter pri Gorici