When Life-Threatening Injuries Overshadow Soft Tissue Trauma: A Missed Morel-Lavallée Lesion

Morel-Lavallée lesions are closed, shearing injuries that occur in polytrauma patients, most commonly affecting the thigh, hip, and pelvis due to mobile skin over thick fascia. These lesions are often missed upon initial evaluation due to the severity of accompanying traumatic injuries and the focus on life-threatening conditions. We present a case of a missed Morel-Lavallée lesion in a Level 1 trauma patient and our innovative approach to treatment. A 36-year-old female patient was air-transported to the emergency department after a motorcycle accident, where she was struck by a vehicle. She arrived intubated with a Glasgow Coma Scale of 3, sustaining a skull fracture and multiple injuries requiring exploratory laparotomy and fracture fixation. Amidst these critical injuries, a Morel-Lavallée lesion in the right anterior-medial thigh was overlooked. On hospital day 10, the patient developed increasing pain and swelling in her right thigh, prompting further evaluation. A computed tomography (CT) scan revealed the Morel-Lavallée lesion. The lesion, now with an eschar, was managed with serial washouts, debridements, and wound vacuum-assisted therapy. Persistent pain and inflammation necessitated surgical intervention, revealing dermal and subcutaneous defects. Treatment included split-thickness skin grafts, autologous skin harvesting, autografts, and dermal substitute application, followed by vacuum-assisted closure. The patient underwent a final wound washout three weeks later before discharge to rehabilitation. This case highlights how Morel-Lavallée lesions are easily missed in the acute setting due to the prioritization of life-threatening injuries. Recognizing and managing these lesions is crucial to preventing complications such as infection and skin necrosis. This case provides insight into both operative and non-operative innovative treatment strategies for these complex soft tissue injuries.