[Surgical treatment of Morel-Lavallée lesion with perineal lacerations]

To investigate the surgical treatments of Morel-Lavallée lesion with perineal lacerations.

From March 2003 to June 2009, 18 cases of Morel-Lavallée lesion with perineal lacerations were treated. There were 16 males and 2 females with a median age of 28.5 years (range, 3-54 years). The time between the injury and hospitalization ranged from 3 hours to 7 days. The lesions were in the greater trochanter (2 cases), the gluteal (2 cases), the lumbar flank (1 case), the lumbar sacrum (3 cases), the pelvic girdle (7 cases), and the hip (3 cases). All the cases were complicated with perineal lacerations, which included male genitalia defect (2 cases), mangled genitalia (2 cases), and genitalia injuries with anal injuries (14 cases). The main treatments included repeated debridement, external fixation of fractures, vacuum sealing drainage, skin grafting, reconstruction of genitalia, and anoplasty.

Three cases died after operation. Two cases died of multiple system organ failure, 1 case died of septic shock. Three cases were amputated and the causes were mangled extremities (2 cases) and osteofascial compartment syndrome (1 case). In 15 survivors, the average time of operations was 3.6 times (range, 3-8 times) and the average hospitalization days was 43.3 days (range, 32-108 days). After a follow-up of 6 months to 2 years, all perineal wounds healed. Annals recovered the normal defecation while one with ostomy was waiting for the secondly resetting of the bowels.

The treatments of Morel-Lavallée lesion with perineal lacerations were significantly different from simple close Morel-Lavallée lesion. With high mortality and disability, Morel-Lavallée lesion with perineal lacerations require more challenging treatment protocols among which the most important is the soft tissue management and nutrition. The satisfactory outcomes come from joint efforts of multiple departments.