DIAGNOSIS AND MANAGEMENT OF CLOSED INTERNAL DEGLOVING INJURIES ASSOCIATED WITH PELVIC AND ACETABULAR FRACTURES - THE MOREL-LAVALLEE LESION

Closed internal degloving is a significant soft-tissue injury associat ed 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 inte rnal degloving occurs over the greater trochanter, it is known as a Mo rel-Lavallee lesion. We reviewed 24 patients who sustained a closed in ternal degloving injury. Cultures from the closed internal degloving i njury were positive in 46% (11 of 24 cases). The incidence of positive cultures was not dependent on the time from injury to debridement. Al l 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 de bridement. One patient whose wound was primarily closed over suction d rains developed a chronic deep soft-tissue infection requiring multipl e debridements. The development of hematoma in the zone of operation r educes the safety of early operative intervention by increasing the ri sk of infection. An expanding hematoma in a closed internal degloving injury may further compromise the skin vascularity if not promptly dra ined. The injured soft tissues should be debrided early, either before or at the time of fracture fixation. The wound should be left open, a nd repeated surgical debridement of the injured tissue is recommended.