Session Time: 11:15am-12:45pm
Location: Research Hub - Kiosk 2
Disclosures: Eric E. Twohey: Nothing to disclose
Case Description: Six weeks post-injury, his femur x-rays showed healing. His knee immobilizer was removed. The next day, he developed a large medial thigh fluid collection. CT and ultrasound demonstrated that the fluid was superficial to fascia, consistent with a ML lesion. It measured 16 cm by 8 cm by 25 cm. It did not communicate with surgical hardware. Lesion-related pain and intermittent loss of overlying cutaneous sensation interfered with progress in therapies. Three days later, after 1400 mL was drained under ultrasound, he was able to ambulate nearly 400 feet with a walker, gait speed 0.28 m/S. Over the next 2 months, it was drained five additional times for volumes of 730 mL to 1700 mL. Cultures taken during the third procedure grew Staphylococcus aureus, requiring antibiotics. After each drainage, ambulation distance and gait speed increased. He noted less discomfort and better sensation. His symptoms also responded favorably to compression therapy.
Setting: Acute Rehabilitation Unit (ARU), VA Hospital.
Patient: A 57-year-old with end-stage liver failure injured his brain, spine and limbs when his riding lawnmower struck a root and rolled into a ditch. Surgeries included left distal femur intramedullary nail repair. He admitted to ARU 32 days post-injury.
Assessment/Results: The lesion did not appear amenable to surgical treatment, so sclerotherapy was implemented. After three treatments, the fluid collection size was negligible. By that point, he was walking more than 900 feet, gait speed 0.34 m/S.
Discussion: ML lesions result when violent shear force pulls subcutaneous fat and skin away from underlying fascia, allowing blood, fat, and lymphatic fluid to accumulate in between. These lesions are rare, occurring in fewer than 2% of pelvic and thigh injuries. Sequelae can include delayed healing, pain, recurrence, skin necrosis, and infection.
Conclusion: In this unique case, liver disease contributed to the large size and protracted nature of a Morel-Lavallee lesion. Interdisciplinary treatment optimized function during his complicated course.
Level of Evidence: Level V
To cite this abstract in AMA style:Twohey EE, Day AR, Mortimer D. Morel-Lavallee (ML) Lesion Complicating Recovery from Lawnmower Rollover: A Case Report [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/morel-lavallee-ml-lesion-complicating-recovery-from-lawnmower-rollover-a-case-report/. Accessed December 1, 2021.
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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/morel-lavallee-ml-lesion-complicating-recovery-from-lawnmower-rollover-a-case-report/