Surgical treatment of a Morel-Lavallée lesion of the distal thigh with the use of lymphatic mapping and fibrin sealant.

Abstract

A Morel-Lavallée lesion can occur after a closed degloving injury. It is a persistent seroma that may be resistant to conservative methods of treatment such as percutaneous drainage and compression therapy. We present a novel, successful method of surgical treatment. A 70 year-old lady developed a 30 × 15 cm rapidly enlarging right medial thigh/knee swelling after being hit by a car. Conservative treatments failed, sarcoma was excluded, and the diagnosis confirmed, by MR imaging and cytology prior to referral. The lesion was excised, and blue dye lymphatic mapping used to identify and ligate feeding lymphatic vessels. The cavity was then closed using fibrin sealant spray and resorbable quilting sutures. A pressure garment was fitted. The wound healed without complication, with no recurrence at six months. The patient returned to normal activities without pressure garments. This method provides a novel, successful approach to the surgical treatment of a chronic Morel-Lavallée lesion.