Hak D J, Olson S A, Matta J M
Section of Orthopaedic Surgery, University of Michigan, Ann Arbor, USA.
J Trauma. 1997 Jun;42(6):1046-51. doi: 10.1097/00005373-199706000-00010.
Closed internal degloving is a significant soft-tissue injury associated with a pelvic trauma in which the subcutaneous tissue is torn away from the underlying fascia, creating a cavity filled with hematoma and liquefied fat. It commonly occurs over the greater trochanter but may also occur in the flank and lumbodorsal region. When this closed internal degloving occurs over the greater trochanter, it is known as a Morel-Lavallée lesion. We reviewed 24 patients who sustained a closed internal degloving injury. Cultures from the closed internal degloving injury were positive in 46% (11 of 24 cases). The incidence of positive cultures was not dependent on the time from injury to debridement. All wounds were treated by thorough debridement before or during pelvic or acetabular surgery. Three patients subsequently developed deep-bone infections, only one of whom had a positive culture at the initial debridement. One patient whose wound was primarily closed over suction drains developed a chronic deep soft-tissue infection requiring multiple debridements. The development of hematoma in the zone of operation reduces the safety of early operative intervention by increasing the risk of infection. An expanding hematoma in a closed internal degloving injury may further compromise the skin vascularity if not promptly drained. The injured soft tissues should be debrided early, either before or at the time of fracture fixation. The wound should be left open, and repeated surgical debridement of the injured tissue is recommended.
闭合性内部脱套伤是一种与骨盆创伤相关的严重软组织损伤，皮下组织从其下方的筋膜撕脱，形成一个充满血肿和液化脂肪的腔隙。它通常发生在大转子处，但也可能发生在侧腹和腰背部区域。当这种闭合性内部脱套伤发生在大转子处时，称为莫雷尔-拉瓦利损伤。我们回顾了24例发生闭合性内部脱套伤的患者。闭合性内部脱套伤的培养物在46%（24例中的11例）呈阳性。培养物阳性的发生率与受伤至清创的时间无关。所有伤口均在骨盆或髋臼手术前或手术期间进行了彻底清创。3例患者随后发生了深部骨感染，其中只有1例在初次清创时培养物呈阳性。1例伤口在负压引流管上一期闭合的患者发生了慢性深部软组织感染，需要多次清创。手术区域血肿的形成通过增加感染风险降低了早期手术干预的安全性。如果不及时引流，闭合性内部脱套伤中不断扩大的血肿可能会进一步损害皮肤血管。受伤的软组织应在骨折固定前或骨折固定时尽早进行清创。伤口应敞开，建议对受伤组织进行反复手术清创。
