An unusual presentation of morel- lavallee lesion in the arm: a case report

Abstract

Morel-lavallee lesions (MLL) are post traumatic closed internal de-gloving injury with abrupt separation of skin and subcutaneous tissue from the underlying fascia. The shearing force damages the blood vessels and lymphatics, resulting in collection of the serosanguinous fluid and necrotized fat. Early diagnosis and management minimize complications like infections or extensive skin necrosis. MLLs commonly described in pelvic and lower extremity trauma, and there are limited reports in other locations. A 28-year-old male presented with pain and swelling over the left elbow for 6 days with multiple deep bruises over the skin extending from mid arm to proximal forearm.  Ultrasound of the arm revealed a large encapsulated collection consistent with MLL. An open debridement with excision of all necrotic skin and necrotic tissue was performed followed by skin grafting. Intra-operative cultures were negative and pathology was consistent with MLL. Morel-lavallee lesions should always be considered as early diagnosis of previous trauma regardless the location. The key to recognize this injury depends on suspicious mechanism involving significant shear forces. Aggressive surgical debridement remains the key to prevent significant morbidity and mortality.