Sarani Nikta, Ahluwalia Amandeep, Buchanan Anna, Kartiko Susan, Quintana Megan T
From the Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, DC.
J Trauma Acute Care Surg. 2025 Sep 4. doi: 10.1097/TA.0000000000004789.
The Morel-Lavallée lesion (MLL) is a rare closed degloving injury resulting from traumatic shearing forces that separate subcutaneous tissue from underlying fascia, creating a cavity filled with blood, lymph, and inflammatory exudate. Typically occurring in regions where skin can glide significantly over rigid structures, such as the thigh, MLLs present as fluctuant, boggy, sometimes painful lesions, which result from disrupted lymphatic and vascular structures. The lesion evolves through an inflammatory cascade leading to eventual encapsulation by dense fibrotic tissue. While the diagnosis is primarily clinical, imaging, particularly magnetic resonance imaging, assists in confirming lesion presence, assessing chronicity, and differentiating MLLs from other pathologies such as bursitis, hematomas, and sarcomas. Treatment strategies range from conservative approaches, including compression and aspiration for smaller lesions, progressing to minimally invasive procedures, such as percutaneous drainage and sclerotherapy, to operative intervention involving open drainage and debridement for larger, recurrent, or infected collections. Future advancements in standardized treatment guidelines, novel imaging modalities, and multidisciplinary rehabilitation are crucial for improving early recognition, therapeutic outcomes, and minimizing morbidity associated with MLLs.
Systematic review; Level I.
莫雷尔-拉瓦利损伤(MLL)是一种罕见的闭合性脱套伤,由创伤性剪切力导致皮下组织与深层筋膜分离,形成一个充满血液、淋巴液和炎性渗出物的腔隙。MLL通常发生在皮肤可在坚硬结构上显著滑动的区域,如大腿,表现为波动性、松软、有时疼痛的损伤,这是由淋巴管和血管结构破坏所致。该损伤通过炎症级联反应发展,最终被致密的纤维组织包裹。虽然诊断主要依靠临床,但影像学检查,尤其是磁共振成像,有助于确认损伤的存在、评估损伤的慢性程度,并将MLL与其他病理情况如滑囊炎、血肿和肉瘤相鉴别。治疗策略从保守方法,包括对较小损伤进行压迫和抽吸,到微创手术,如经皮引流和硬化治疗,再到对较大、复发性或感染性积液进行开放引流和清创的手术干预。标准化治疗指南、新型成像模式和多学科康复方面的未来进展对于提高早期识别、治疗效果以及将与MLL相关的发病率降至最低至关重要。
系统评价;I级。