University of Pittsburgh Medical Center, Department of Plastic Surgery, USA.
University of Pittsburgh Medical Center, Department of Plastic Surgery, USA.
Injury. 2024 Nov;55(11):111762. doi: 10.1016/j.injury.2024.111762. Epub 2024 Jul 31.
Morel-Lavallee Lesions lead to disruption of lymphatic anatomy that require early identification and may necessitate lymphatic reconstruction. We present the case of a 59-year-old male with lower extremity lymphedema resulting after a severe Morel-Lavallee lesion and treated using lymphovenous anastomoses. He was initially managed with multiple aspirations followed by repeat incision and drainage. At 10 months following his injury, he continued to have swelling of his upper thigh and developed a large festoon medially, with lower leg pitting edema. He was diagnosed with lymphedema via lymphoscintigraphy. His superficial lymphatic anatomy was visualized using indocyanine green (ICG) lymphography and showed diffuse dermal backflow across his thigh, with signs of altered lymphatic anatomy distally. We preformed two lymphovenous anastomoses at the level of his mid-thigh to bypass the lymphatic disruption and restore drainage to his lower leg. After rerouting lymphatic flow from the lower extremity, the patient had overall improvement of his symptoms and reduced swelling with continued therapy. At 5 months postoperatively, his volumetric lower extremity measurements showed a decrease by 314 mL and he began walking again in 20-minute intervals. Lymphedema may be an important consideration following severe Morel-Lavallee lesions. Using modern diagnostic and supermicrosurgical techniques, plastic surgeons can help treat this long-term morbidity.
Morel-Lavallee 损伤导致淋巴管解剖结构破坏，需要早期识别，可能需要淋巴管重建。我们报告了一例 59 岁男性患者，因严重的 Morel-Lavallee 损伤导致下肢淋巴水肿，采用淋巴管静脉吻合术治疗。他最初接受了多次抽吸治疗，随后进行了多次切开引流。损伤后 10 个月，他的大腿上部仍有肿胀，并在中部形成一个大的悬垂，小腿有凹陷性水肿。通过淋巴闪烁显像术诊断为淋巴水肿。使用吲哚菁绿（ICG）淋巴管造影术显示他的浅表淋巴管解剖结构，大腿部弥漫性真皮逆流，远端淋巴管解剖结构改变。我们在他的大腿中部进行了两次淋巴管静脉吻合术，以绕过淋巴破坏，恢复下肢引流。重新引导下肢淋巴液流动后，患者的症状总体改善，肿胀减轻，继续接受治疗。术后 5 个月，他的下肢体积测量值减少了 314 毫升，他开始能够每隔 20 分钟行走一次。严重的 Morel-Lavallee 损伤后可能需要考虑淋巴水肿。整形外科医生可以利用现代诊断和超显微外科技术来帮助治疗这种长期的并发症。
