Ismail Allyzain, Nyamuryekung'e Masawa, Rajeev Kumar
The Aga Khan University, East Africa Medical College, P. O. Box 2289, Barack Obama Drive, Dar es Salaam, Tanzania.
Department of Surgery, The Aga Khan Hospital, P. O. Box 2289, Barack Obama Drive, Dar es Salaam, Tanzania.
Int J Surg Case Rep. 2021 Feb;79:343-349. doi: 10.1016/j.ijscr.2021.01.067. Epub 2021 Jan 20.
A Morel-Lavallee lesion is a closed degloving injury due to traumatic separation of the hypodermis from underlying fascia. Accumulation of hemolymphatic fluid that occurs is a potential habitat for bacteria. Management options include percutaneous aspiration, open debridement, or a non-surgical approach, each with recurrence risk. In the event of recurrence, sclerotherapy is used. In this case report, after reviewing povidone iodine's efficacy in treating seromas, we used it as a sclerosant for recurrent Morel-Lavallee lesion as the more established options were unavailable in our setting.
A 49-year-old with no known comorbid presented following a motor traffic accident, with left lateral thigh swelling. He was stable systematically, with a tense, tender left lateral thigh swelling and intact neurovascular assessment distally. X-ray and computed tomography ruled out skeletal and vascular injuries. Magnetic resonance imaging revealed a 580 ml type 1 Morell-Lavallee lesion. Open surgical debridement was done to drain and debride the lesion. He developed two recurrences that necessitated percutaneous aspiration. Doxycycline and talc sclerosants were considered; however, due to their unavailability, povidone iodine was used. It is now five months post-intervention without increased pain, recurrence, or wound complications.
Recurrence is hypothesized to be due to the persistence of fluid loculations, unobliterated dead space, and pseudocyst formation. Sclerotherapy stimulates inflammation that results in fibrosis of the cavity walls causing its obliteration. Doxycycline, the most studied sclerosant in Morel-Lavallée lesion has an efficacy of 95.7%.
The current report is the first successful use of povidone iodine for sclerotherapy of recurring Morel-Lavallée lesions. Based on povidone iodine experiences as a sclerosant, it is associated with increased analgesic requirements. We cautiously propose its use as an alternative in settings where talc powder and doxycycline powder are unavailable.
莫雷尔-拉瓦利损伤是一种因皮下组织与深层筋膜创伤性分离导致的闭合性脱套伤。所形成的血淋巴液积聚是细菌的潜在滋生地。治疗选择包括经皮抽吸、开放清创或非手术方法，每种方法都有复发风险。复发时，采用硬化疗法。在本病例报告中，在评估聚维酮碘治疗血清肿的疗效后，由于我们所在环境中没有更成熟的选择，我们将其用作复发性莫雷尔-拉瓦利损伤的硬化剂。
一名49岁无已知合并症的患者在机动车交通事故后出现左侧大腿肿胀。他全身情况稳定，左侧大腿外侧肿胀、紧张、压痛，远端神经血管评估正常。X线和计算机断层扫描排除了骨骼和血管损伤。磁共振成像显示有一个580毫升的1型莫雷尔-拉瓦利损伤。进行了开放手术清创以引流和清理损伤部位。他出现了两次复发，需要经皮抽吸。考虑使用强力霉素和滑石粉硬化剂；然而，由于无法获得这些药物，使用了聚维酮碘。目前干预后已过去五个月，没有疼痛加剧、复发或伤口并发症。
复发被推测是由于液体分隔持续存在、死腔未闭塞和假囊肿形成。硬化疗法刺激炎症，导致腔壁纤维化，从而使其闭塞。强力霉素是在莫雷尔-拉瓦利损伤中研究最多的硬化剂，有效率为95.7％。
本报告是首次成功使用聚维酮碘对复发性莫雷尔-拉瓦利损伤进行硬化治疗。基于聚维酮碘作为硬化剂的经验，它与镇痛需求增加有关。我们谨慎地建议在无法获得滑石粉和强力霉素粉的情况下将其作为一种替代方法使用。
