Clinical presentation and management of pelvic Morel–Lavallee injury in obese patients

• Main Authors: Mohammed Muneer, Ayman El-Menyar, Husham Abdelrahman, Musab Ahmed Murad, Sara M Al Harami, Ahmed Mokhtar, Mahwish Khawar, Ahmed Awad, Mohammad Asim, Rifat Latifi, Hassan Al-Thani
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2019-01-01
• Series: Journal of Emergencies, Trauma and Shock
• Subjects: Degloving; injury; Morel–Lavallee lesion; obesity; pelvis; trauma
• Online Access: http://www.onlinejets.org/article.asp?issn=0974-2700;year=2019;volume=12;issue=1;spage=40;epage=47;aulast=Muneer

Introduction: Morel–Lavallee lesion (MLL) is an infrequent or underreported serious consequence of closed degloving injuries. We aimed to describe the clinical presentation and management of pelvic MLL in obese patients. Materials and Methods: A retrospective analysis was conducted for pelvic trauma patients with a diagnosis of MLL between 2010 and 2012. Patients' demographics, presentations, management, and outcomes were analyzed and compared based on the body mass index (BMI) and injury severity. Results: Of 580 patients with pelvic region injuries, 183 (31.5%) had MLL with a mean age of 30.1 ± 12.2 years. The majority (75.4%) of MLL patients had a BMI ≥30 and 44% patients had pelvic fracture. Based on the initial clinical examination, MLL was diagnosed in 84% of patients and clinically missed in 16% of patients. Nonoperative management (NOM) was performed in 93.4% of patients, while primary surgical intervention was indicated in 6.6% of patients. Failed NOM was observed in seven cases, of them five were obese. The overall mortality in MLL patients was 12.6% and the frequency of deaths was nonsignificantly higher in Grade I obese patients. Multivariate analysis showed that injury severity score (odds ratio [OR]: 1.25, 95% confidence interval [CI]: 1.05–1.50) and Glasgow coma scale (OR: 0.72, 95% CI: 0.56–0.92) were the predictors of mortality in patients with MLL irrespective of BMI. Conclusions: One-third of pelvic region injuries have MLL and three-quarter of them are obese. This significant association of obesity and MLL needs further prospective evaluation.