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Forum: OWL Lists: Orthopod:
Morel Lavallee lesion

 

 


professor_eid at yahoo
New User

Oct 22, 2006, 1:18 PM

Post #1 of 5 (3926 views)
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Morel Lavallee lesion Can't Post

Hello all
This list has been strangely quiet for a whole week. I know that we, Muslims, were in the last week of our fasting month, Ramadan, and are expecting this week our feast, but where is everyone else?

This is a case I hope will stir some discussion.

I recently operated on a female with a fractured acetabulum through a kocher Langenbeck approach. The interval between trauma and operation was 2 weeks.
In the distal 1/3 of the incision, over the greater trochanter I was met with a large amount of golden brown fluid, with fat droplets in it. Then I discovered the large dead space under the thick layer of subcutaneous fat.
I fixed the fracture-will post the details some time later- and put a suction drainage and closed the wound hoping that the negative pressure of the drain would close the dead space. A week later, the proximal 2/3 of the incision were healing well and the distal 1/3 was discharging. I went in for a dressing under anaesthesia and debridement. Now three days later, it is still discharging this serosanguinous dicharge.
I would like to know if any of you has had a similar experience, and would welcome any suggestions.
Dr Abdelsalam EID M.D., AFSA (Paris V)
AO Fellow
Lecturer of Orthopedic Surgery
Faculty of Medicine, Zagazig University,
Egypt.
www.doctoreid.com



Krunoslav.Margic at guest
New User

Oct 22, 2006, 2:34 PM

Post #2 of 5 (3926 views)
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Re: Morel Lavallee lesion [In reply to] Can't Post

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.

Krunoslav Margic

Prim.dr. Krunoslav Margic,dr.med
Department of Plastic and Reconstructive Surgery
General Hospital
Sempeter pri Gorici
Slovenija


professor_eid at yahoo
New User

Oct 23, 2006, 11:51 AM

Post #3 of 5 (3924 views)
Shortcut
Re: Morel Lavallee lesion [In reply to] Can't Post

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)
AO Fellow
Lecturer of Orthopedic Surgery
Faculty of Medicine, Zagazig University,
Egypt.
www.doctoreid.com



----- Original Message ----
From: Krunoslav Margiæ <Krunoslav.Margic@guest.arnes.si>
To: orthopod@orthogate.com
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.

Krunoslav Margic

Prim.dr. Krunoslav Margic,dr.med
Department of Plastic and Reconstructive Surgery
General Hospital
Sempeter pri Gorici
Slovenija



rajesh84 at asianetindia
New User

Oct 23, 2006, 7:58 PM

Post #4 of 5 (3924 views)
Shortcut
RE: Morel Lavallee lesion [In reply to] Can't Post

There was a discussion on the ORT-L list some time ago but I can't find the
relevant email. I think the gist of it was debridemement and open packing to
allow granulation.


rajesh

Dr.K.R.Rajesh, MS,DipNB,FRCS,FRCS(Orth)
Consultant Upper Limb Surgeon
Division of Upper Limb , Arthroscopy & Joint Replacement Surgery.
Cosmopolitan Hospital
Trivandrum,Kerala,India.

Mobile-9447191205
-----Original Message-----
From: Dr Eid [mailto:professor_eid@yahoo.com]
Sent: 23 October 2006 01:49
To: orthopod@orthogate.com
Subject: Morel Lavallee lesion


Hello all
This list has been strangely quiet for a whole week. I know that we,
Muslims, were in the last week of our fasting month, Ramadan, and are
expecting this week our feast, but where is everyone else?

This is a case I hope will stir some discussion.

I recently operated on a female with a fractured acetabulum through a
kocher Langenbeck approach. The interval between trauma and operation was 2
weeks.
In the distal 1/3 of the incision, over the greater trochanter I was met
with a large amount of golden brown fluid, with fat droplets in it. Then I
discovered the large dead space under the thick layer of subcutaneous fat.
I fixed the fracture-will post the details some time later- and put a
suction drainage and closed the wound hoping that the negative pressure of
the drain would close the dead space. A week later, the proximal 2/3 of the
incision were healing well and the distal 1/3 was discharging. I went in for
a dressing under anaesthesia and debridement. Now three days later, it is
still discharging this serosanguinous dicharge.
I would like to know if any of you has had a similar experience, and would
welcome any suggestions.
Dr Abdelsalam EID M.D., AFSA (Paris V)
AO Fellow
Lecturer of Orthopedic Surgery
Faculty of Medicine, Zagazig University,
Egypt.
www.doctoreid.com




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phadke_ajit at hotmail
New User

Oct 24, 2006, 10:53 AM

Post #5 of 5 (3922 views)
Shortcut
Re: Morel Lavallee lesion [In reply to] Can't Post

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
Ajit Phadke
Consultant
Yavatmal, India
----- Original Message -----
From: Dr Eid
To: orthopod@orthogate.com
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)
AO Fellow
Lecturer of Orthopedic Surgery
Faculty of Medicine, Zagazig University,
Egypt.
www.doctoreid.com



----- Original Message ----
From: Krunoslav Margiæ <Krunoslav.Margic@guest.arnes.si>
To: orthopod@orthogate.com
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.

Krunoslav Margic

Prim.dr. Krunoslav Margic,dr.med
Department of Plastic and Reconstructive Surgery
General Hospital
Sempeter pri Gorici
Slovenija





 
 
 


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