A Case Coalition on Post-Traumatic Tumid: The Morel-Lavallee Lesion

Background: Morel-Lavallée lesion (MLL) is an uncommon closed degloving injury in which the subcutaneous tissue is sheared off the underlying fascia or muscle after blunt trauma. It is easily mistaken for a simple hematoma, which can delay diagnosis and lead to recurrence. The objective is to describe the clinical presentation, imaging features, management, and outcomes of six patients with MLL of the thigh and calf. Material and Methods: We retrospectively reviewed six patients (three men, three women; aged 37 to 60 years) who presented with pain and swelling of the calf (n = 3) or thigh (n = 3) after low-energy blunt trauma, including falls from two-wheelers, a slip and fall, a fall at home, and being hit by a two-wheeler. Clinical findings, imaging (ultrasonography or MRI), treatment, histopathology, and follow-up were recorded. Results: Presentation ranged from 15 days to 3 months after injury. Each patient had a solitary, smooth, soft, fluctuant swelling measuring 8 × 5 cm to 25 × 18 cm. Ultrasonography (n = 4) or MRI (n = 2) showed a fluid collection, anechoic or T2 hyperintense, between the deep subcutaneous tissue and the muscle, with septations in one case and mixed echogenicity in another. Four patients were managed conservatively with repeated aspiration or drainage and compression bandaging, and the swelling resolved or was recovering at follow-up. Two patients, one after failed outside aspiration, chose surgical excision with suction drain and compression dressing, and histopathology confirmed MLL. There were no complications. Conclusion: MLL should be suspected in any persistent fluctuant swelling of the thigh or calf after blunt trauma. Early imaging allows accurate diagnosis. Aspiration with compression is a reasonable first-line option for smaller lesions, while large, multiloculated, or aspiration-resistant lesions may require surgical excision.

Keywords: Morel-Lavallée lesion, Soft-tissue degloving injury, post-traumatic swelling, hematoma, blunt trauma, aspiration, compression.