From the Division of Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester, Minnesota.
J Trauma Acute Care Surg. 2014 Feb;76(2):493-7. doi: 10.1097/TA.0000000000000111.
Although uncommon, Morel-Lavallée lesions (also called closed degloving injuries) are associated with considerable morbidity in trauma patients. There is lack of consensus regarding proper management of these lesions. Management options include nonoperative therapies, along with percutaneous and operative techniques. We sought to define the factors associated with failure of percutaneous aspiration to better identify patients requiring immediate operative management.
We retrospectively searched our prospectively collected database for patient records containing the terms Morel-Lavallée, closed degloving injury, or posttraumatic seroma from February 2, 2004, through December 23, 2011. Treatment methods included compression wraps or observation (nonoperative management), percutaneous aspiration, or operative management with incision/drainage or formal debridement of skin and soft tissues that resulted in wound vacuum-assisted closure placement and/or split-thickness skin graft (operative management). The treatment groups were compared using univariate analysis and χ testing.
We identified 79 patients with 87 Morel-Lavallée lesions in the setting of trauma. Most were caused by motor vehicle collisions (25%). No difference was observed between the treatment groups in sex, body mass index, anticoagulation treatment, diabetes mellitus, smoking history, or alcohol use. The percutaneous aspiration group had higher rates of recurrence (56% vs. 19% and 15% in nonoperative and operative groups, respectively). The percentage of patients who had aspiration of more than 50 mL of fluid was higher for lesions that recurred than for lesions that resolved (83% vs. 33%, p = 0.02).
Aspiration of more than 50 mL of fluid from Morel-Lavallée lesions was much more common among lesions that recurred (83%) than among those that resolved (33%). We therefore recommend that aspiration of more than 50 mL of fluid from a Morel-Lavallée lesion prompts operative intervention. We have now adopted this as a practice management guideline.
Therapeutic/care management study, level III.
莫莱尔-拉瓦列氏损伤（也称闭合性撕脱伤）虽不常见，但在创伤患者中与相当高的发病率相关。对于这些损伤，缺乏共识的是恰当的治疗方法。治疗方法包括非手术治疗以及经皮和手术技术。我们旨在确定与经皮抽吸失败相关的因素，以便更好地识别需要立即手术治疗的患者。
我们通过检索 2004 年 2 月 2 日至 2011 年 12 月 23 日期间包含术语“Morel-Lavallée”、“闭合性撕脱伤”或“创伤后血清肿”的前瞻性数据库中的患者记录，进行回顾性研究。治疗方法包括加压包扎或观察（非手术治疗）、经皮抽吸或切开/引流或皮肤和软组织的正式清创，随后放置伤口负压辅助闭合和/或刃厚皮片移植（手术治疗）。使用单变量分析和卡方检验比较治疗组。
我们在创伤背景下共鉴定了 79 例 87 个莫莱尔-拉瓦列氏损伤患者。大多数损伤是由机动车碰撞引起的（25%）。治疗组在性别、体重指数、抗凝治疗、糖尿病、吸烟史或饮酒史方面无差异。经皮抽吸组的复发率较高（56%比非手术组和手术组的 19%和 15%）。在复发的损伤中，抽吸超过 50 mL 液体的患者比例高于缓解的损伤（83%比 33%，p = 0.02）。
在复发的莫莱尔-拉瓦列氏损伤中，抽吸超过 50 mL 液体更为常见（83%），而在缓解的损伤中抽吸超过 50 mL 液体则相对较少（33%）。因此，我们建议对莫莱尔-拉瓦列氏损伤抽吸超过 50 mL 液体提示进行手术干预。我们现在已经将其作为一种临床管理指南。
治疗/护理管理研究，III 级。
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