The primary dressings were removed 5 days post-autografting with satisfactory results after 5 weeks, autograft take was noted to be > 95% with further aesthetic improvements appreciated. During the first 24 and 48 post-operative hours, 7 mL of serosanginous fluid were drained, respectively. To prevent re-accumulation of fluid into this dead space, a 19F round Blake drain was placed in the dependent portion of the MLL, the overlying cutaneous defect was grafted with a 2:1 meshed split-thickness skin autograft, a negative pressure dressing was used to bolster the graft, and an abdominal binder was worn at all times. Upon further excision of necrotic adipose tissue, the underlying fascial-cutaneous separation (MLL) was discovered, and approximately 1.5 L of serosanguinous fluid was evacuated from this cavity. Upon return to the OR 5 days later for planned excision of allograft and placement of autograft, significant progression of burn depth and adipose necrosis was noted and the left flank was distended and edematous. The patient was taken to the operating room (OR) for an uncomplicated tangential excision and allografting of the abdominal friction burn. The burn service was consulted on hospital day 5 for management of her abdominal friction burns (TBSA 13%), of which 4% appeared to be full thickness on initial evaluation. Additional radiologic findings included a small bowel mesenteric hematoma, managed non-operatively, a small left flank hematoma, and six-rib fractures. Initial trauma evaluation revealed a left sided closed femur fracture, treated with intramedullary (IM) nailing, and a humerus fracture with open reduction internal fixation (ORIF). We describe a case of a full-thickness abdominal friction burn overlying, and complicated by, an MLL internal degloving injury.Ī 30-year-old obese (BMI 35.3) female was struck by a tow truck and dragged for 30 ft. The reported incidence of MLL’s in the literature ranges from 2 to 12% in the setting of pelvic fractures. Disrupted perforating vessels along fascial planes are the main source of continued fluid accumulation, and given the large capacity for fluid in the thigh, pelvic, and abdominal regions (especially in obese patients), patients with MLL may require larger volume resuscitation and may demonstrate ongoing blood or fluid requirements. MLLs occur when a sheering force creates an open space between the skin and fascia which, over time, fills with blood and/or serous fluid and then has the potential for infection or organization into more chronic cystic structures. Most MLLs and closed internal degloving injuries have been described in the orthopedic literature, typically associated with traumatic injuries to the extremities, pelvic region, or greater trochanter. The first report of a MLL was by the French physician Maurice Morel-Lavallee, in 1853, and was associated with pelvic trauma. Unlike friction burns to the skin, which are easy to recognize, many MLLs are often missed entirely at initial evaluation. Other names for these lesions are post-traumatic cysts, post-traumatic pseudocysts, Morel-Lavallee effusion, or Moral-Lavallee hematoma. Morel-Lavallee lesions (MLLs) are rare traumatic injuries caused by a shearing force, which cause internal degloving of soft tissue. A friction burn injury, such as road rash, occurs when skin is abraded by contact with a hard object and often involves both physical abrasion to skin and a burn from the heat generated by the friction. Most friction or flame burn injuries are appreciated during the primary trauma survey but may later be neglected or overlooked by more severe injuries. Surgeons must maintain a high index of suspicion when dealing with third degree friction burns as they may mask underlying injuries such as MLL, and a delay in diagnosis can lead to increased morbidity. MLL is a rare, often overlooked, internal degloving injury. The internal degloving caused significant devascularization of the overlying soft tissue and skin which required surgical drainage of hematoma, abdominal wall reconstruction with tangential excision, allografting, negative pressure wound therapy, and ultimately autografting. We present a 30-year-old female pedestrian struck by a motor vehicle who sustained multiple long bone fractures, a mesenteric hematoma, and full-thickness abdominal skin friction burn which masked a significant underlying abdominal MLL. MLL is often overlooked in the setting of poly-trauma therefore, clinicians must maintain a high degree of suspicion and be familiar with the management of such injuries, especially in obese poly-trauma patients. Morel-Lavallee lesions (MLLs) are rare internal degloving injuries typically caused by blunt traumatic injuries and most commonly occur around the hips and in association with pelvic or acetabular fractures.
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