Degloving in Disguise: Managing a Delayed Spinal Morel-Lavallée Lesion after Thoracic Fracture-Dislocation

Back-degloving injuries are rare but severe consequences of high-energy blunt trauma. These injuries involve the separation of skin and subcutaneous tissue from the underlying fascia, muscle, or bone, and may present as open or closed lesions. Closed injuries, or Morel-Lavallée lesions, can be particularly insidious due to intact dermis concealing deep fluid accumulation, necrosis, and infection.

We present the case of a 61-year-old male who sustained extensive polytrauma following a motorcycle-versus-car collision, with emphasis on his spinal injuries and delayed-onset closed thoracolumbar degloving lesion. Spinal injuries consisted of a T11-T12 fracture-dislocation. Initial management of the spinal lesion included debridement of the wound and posterior spinal fusion. In the post-operative period, he developed increasing dorsal soft-tissue swelling, wound dehiscence, and purulent discharge. The lesion was managed with serial incision and drainage procedures, negative pressure wound therapy, and broad-spectrum intravenous antibiotics. He was later discharged with negative wound and blood cultures and a closed wound, though he was later readmitted.

This case underscores the complexity of managing spinal trauma complicated by closed degloving injuries and highlights the critical need for early recognition, advanced imaging, and a multidisciplinary approach to optimize outcomes in polytrauma patients. Clinicians should maintain a high index of suspicion for closed infections or degloving injuries in patients with persistent or evolving tissue swelling overlying spinal instrumentation. A delayed diagnosis may precipitate wound breakdown, hardware compromise, and chronic infection. Prompt imaging and more frequent physical examinations, as well as coordinated management by different surgical teams, are essential to mitigate the morbidity from these injuries.