[Morel-Lavallee syndrome after crush injury]

Closed internal degloving is a significant soft tissue injury associated with 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, buttock and lumbodorsal region, and it is known as a Morel-Lavallee lesion. The diagnosis of closed degloving injuries is based on physical and ultrasonographic examinations. The presence of a soft fluctuant area is the hallmark physical finding. Decreased cutaneous sensation is often associated with the skin over the area of degloving. Local contusion or other signs of injuries such as tire marks may also be present. In two separate cases, a 26-year-old woman and a 67-year-old man were injured in low velocity automobile accidents. During hospitalization, subcutaneous swellings were diagnosed as internal degloving injuries, and were drained several times by a plastic surgeon. A follow-up one year later revealed that the woman still suffered from swelling in the buttocks and thigh, though liposuction was successfully conducted; the man recovered completely from his injury after the conservative treatment. In most cases of degloving injuries, there is bruising of the skin or superficial hematoma, which resorbs spontaneously. However, in some cases, injury to the subcutaneous fatty tissue can result in the formation of a pseudocyst due to lymphatic extravasation. When hematoma or fluid collection does occur, puncture drainage and pressure therapy is usually considered to be sufficient treatment. Otherwise, surgical intervention must be proposed.