Disclosures: Edward Kim, MD: No financial relationships or conflicts of interest

Case Diagnosis: A 68-year-old female with a large Morel-Lavallée lesion.

Case Description: A 68-year-old female initially presented for posterolateral hip swelling. Her history was notable for sustaining a right pelvic fracture five months prior to presentation. The patient underwent ORIF at that time. Over the next five months, the patient developed progressive swelling and pain of her posterolateral hip. Subsequent MRI revealed a large Morel-Lavallée lesion (10.3 cm by 13.3 cm).

Setting: Outpatient musculoskeletal practice.Assessment/

Results: In-office aspiration of the lesion was performed under ultrasound guidance. A total of 1305 mL of brown-yellow fluid with necrotic fat was aspirated. 100 mg of doxycycline was reconstituted in 5 mL of sterile normal saline and then divided and injected into three separate areas of the lesion. At her four-week follow-up visit, ultrasound examination revealed re-accumulation of fluid. Repeat aspiration of the lesion resulted in a total of 245 mL of yellow fluid without necrotic fat. She underwent a repeat doxycycline injection at this time. Three weeks later, a repeat MRI demonstrated a re-accumulation of fluid (9.4 cm by 7.5 cm). She was referred to surgery for open debridement and wound VAC closure.

Discussion: Morel-Lavallée lesions are rare degloving soft tissue injuries. This case represents the largest documented Morel-Lavallée lesion by volume in the literature. Recent studies have supported the case for conservative management such as doxycycline sclerodesis for smaller lesions. Previously, the largest volume lesion that has been successfully treated with doxycycline is 700mL. This case demonstrates the largest lesion to trial, and subsequently fail, conservative management.

Conclusion: The treatment of Morel-Lavallée lesions has evolved over time to favor conservative options such as doxycycline sclerotherapy. Further investigation is needed to clarify the recommended size/volume cutoffs for surgical versus conservative management for Morel-Lavallée lesions.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/doxycycline-sclerodesis-of-a-large-morel-lavallee-lesion-a-case-report/