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Soft tissue injuries are common in the military, generally producing simple hematomas without the need for intensive evaluation and management. In certain situations, a shearing effect between fascial planes whereby a disruption of the vasculature and lymphatic systems creates a "closed degloving injury" is more generally referred to as a Morel-Lavallée Lesion (MLL). With a consistent pool of blood, lymph, and pieces of soft tissue, an M7LL can cause significant poor cosmesis, chronic pain, and risk secondary infection if left undetected and untreated. Proper diagnosis can be made through the effective use of ultrasound and, if detected early enough, through conservative measures to include needle aspiration and compression sleeves. Prior cases describe chronic MLLs existing for extended periods of time, in some cases years, requiring operative intervention, and in some cases poor outcomes. We present two cases of active duty soldiers presenting with seemingly innocuous injuries found on closer evaluation to have MLL, treated in one case with needle aspiration and compression, in the other with operative management., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Introduction: Finger degloving injuries (FDIs) represent a challenge in hand surgery. When replantation is not possible, several techniques including loco-regional flaps, pocket abdominal flaps and free flaps have been described as methods to provide skin cover and avoid finger shortening. The aim of this study is to present our experience with acellular dermal matrices (ADMs) in the treatment of FDI., Materials and Methods: We retrospectively reviewed the charts of 18 patients who presented with FDI and were treated with ADM between December 2015 and July 2017. Surgical outcomes including complications were analysed, and patient-centred assessments were performed at 12 months of follow-up., Results: The follow-up period ranged from 10 to 20 months. All patients showed good integration and vascularisation of the ADM. All the fingers covered with ADM were firm and soft, with a slim and satisfactory appearance at a mean follow-up of 12 months. No limitations in tendon sliding were observed at dynamic sonography one year after surgery., Conclusion: ADMs could be regarded as a viable option when dealing with FDIs, if replantation is not possible and finger length is to be preserved. On the basis of these results, the surgical treatment of FDI with ADM is a viable option that produces good functional outcomes and cosmetic appearance., (Copyright © 2019 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: The Morel-Lavallée lesion is one of the concomitant soft tissue lesions of pelvic fractures. Its role in spine fractures and its treatment in combination with osteosynthesis of pelvic or spine fractures have not yet been determined. The aim of this study was to analyse the best diagnostic and treatment options of both spine and pelvic fractures combined with Morel-Lavallée lesions (MLL)., Methods: An analysis of the literature was performed via PubMed and Medline. This revealed a total of 197 studies and case reports. After analysing the literature, 19 studies/case reports met our inclusion criteria., Results: There are several diagnostic options for MLL, including ultrasound, computed tomography or MRI. In spinal and pelvic lesions, ultrasound is capable of detecting MLL. Some authors tend to perform open debridement of the MLL, whereas others recommend percutanous treatment. Open debridement and vacuum-assisted closure are recommended in late diagnosed MLL, where primary suture of the soft tissue is impossible. Fracture fixation should be performed simultaneously to treatment of the MLL. Broad-spectrum cephalosporins combined with an aminoglycoside or piperacilline/tazobactam should be initiated., Conclusion: Radical debridement and drainage are recommended, especially when MLL is diagnosed late. Repeated ultrasound examinations should be performed of the surrounding soft tissue of the fracture. When MLL is diagnosed within 2 days, percutanous fracture and MLL treatment should be performed. After more than 2 days, both fracture and MLL should be treated with open debridement, open fracture fixation and primary suture if possible., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt vorliegt., (Georg Thieme Verlag KG Stuttgart · New York.)

Objective: Two different rat models for degloving injury were described in the literature. Our aim in this study is to compare these rat models to determine which one is more reliable and reproducible., Methods: We surgically induced degloving injury on tails and left hindlimbs of Wistar albino rats (n = 8), and sutured the avulsed tissues back in their original positions after a waiting period. We observed the changes in the avulsed flaps every other day for 10 days. At the end of follow-up period we evaluated the lesions in avulsed flaps by macroscopic measurement of necrosis and histological ulcer scoring using the National Pressure Ulcer Advisory Panel (NPUAP) Scale., Results: The average length of necrosis in avulsed tail flaps was 28.42 ± 3.04 mm, whereas there was no necrosis in avulsed hindlimb flaps (p < 0.05). The average ulcer score of the lesions in tail and left hindlimb were 3.42 ± 0.78, and 1.28 ± 0.48, respectively (p < 0.05). Despite the lack of visible necrosis TUNEL staining revealed an increased amount of apoptotic cells in avulsed hindlimb flaps. Literature review revealed a significant variability in previous studies in terms of the amount of necrosis observed in tail degloving injury model., Conclusion: Tail degloving injury model proved to be a more reliable animal model for degloving injuries. However, standardization of the magnitude of degloving force is required to decrease the variability of necrosis observed in the literature., (Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. All rights reserved.)

Unilateral ankle swelling is a relatively common presenting complaint among athletes and non-athletes. Due to its broad differential diagnosis, a comprehensive evaluation beginning with history and physical examination are recommended. Imaging including plain radiography, ultrasound (US), and magnetic resonance imaging (MRI) are preferred modalities. Aspiration of a local fluctuating mass may help with the diagnosis and management of some of these conditions. Morel-Lavallée lesion (MLL) is a rare condition consisting of a closed degloving injury caused by forces of pressure and shear stress between the subcutaneous tissue and the superficial fascia or bone. Most commonly MLL is found over the greater trochanter and sacrum, but in rare cases can be found in other regions of the body. In most cases concurrent severe injury mechanisms like motor vehicle accidents are present. MLL due to sports injuries are rare. Depending on the stage and type of MLL, therapeutic strategies may vary from compression wraps and aspiration to surgical evacuation. We present a case of a 65-year-old gentleman with ankle MLL with no known history of a major trauma as a result of playing racquetball 6 weeks earlier. Physical examination revealed a transilluminating lesion in the lateral aspect of his left ankle which was successfully treated with one time aspiration of a serosanguinous fluid. We propose less aggressive methods for management of low-impact sports-related MLL.

In experimental research the method for determining of viability of tissue and device for its realization were developed to improve treatment results degloving injuries of limbs.

Posttraumatic soft tissue swelling is a relatively common presenting complaint among athletes. Due to its broad differential diagnosis, a comprehensive evaluation beginning with history and physical examination are recommended. Imaging including radiography, ultrasound, and magnetic resonance imaging (MRI) are preferred modalities. Aspiration of a fluid collection, preferably under ultrasound guidance, may help with the diagnosis and management of some of these conditions. Morel-Lavallée lesion (MLL) is an uncommon condition consisting of a closed degloving injury caused by forces that create pressure and shear stress between the subcutaneous tissue and the superficial fascia or bone. Most commonly, MLL is found over the greater trochanter and sacrum, but in rare cases can be found in other regions of the body. In most cases, concurrent severe injury mechanisms are present. Sports-related MLL are rare and underreported. Depending on the stage and type of MLL, therapeutic strategies may vary from compression wraps and aspiration to surgical evacuation.

The Morel-Lavallée lesion is a closed soft-tissue degloving injury commonly associated with high-energy trauma. The thigh, hip, and pelvic region are the most commonly affected locations. Timely identification and management of a Morel-Lavallée lesion is crucial because distracting injuries in the polytraumatized patient can result in a missed or delayed diagnosis. Bacterial colonization of these closed soft-tissue injuries has resulted in their association with high rates of perioperative infection. Recently, MRI has been used to characterize and classify these lesions. Definitive management is dictated by the size, location, and age of the injury and ranges from percutaneous drainage to open débridement and irrigation. Chronic lesions may lead to the development of pseudocysts and contour deformities of the extremity.

We report the case of a patient with an extensive degloving injury to his right foot involving severe subcutaneous soft tissue disruption and contamination. The initial treatment consisted of debridement, which was kept to a minimum, copious irrigation, primary wound closure at a few sites, and coverage of the remaining skin defects with vacuum-assisted closure (VAC) dressings. After a few weeks of VAC therapy for wound bed preparation, definitive coverage with a meshed skin graft was possible. Additional plastic surgical procedures were not required. At the last follow-up visit, the patient had no complaints and was able to participate in normal social life without limitations. Wounds that are grossly contaminated or associated with extensive soft tissue defects often require a multistage approach before delayed primary wound closure or plastic surgical procedures can be performed. Vacuum therapy can be used for temporary soft tissue coverage and has been shown to improve bacterial clearance, to increase local blood flow, and to promote granulation tissue formation. In contrast, plastic surgical procedures initially achieve safe and stable wound closure; however, the absence of sensitivity can lead to secondary problems. This is of particular relevance if the graft recipient site is subject to heavy stress and the restoration of function is of paramount importance, such as in the present case. Vacuum therapy is an effective and safe treatment of degloving injuries. We achieved a very good functional outcome, which was particularly important in view of the high stresses and strains to which a foot is exposed., (Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Study Design: Case report., Introduction: This case report describes the use of the casting motion to mobilize stiffness (CMMS) technique in the management of a crush and degloving injury of the hand. The patient was unable to attend multiple hand therapy sessions due to geographic constraints. The CMMS technique involved the application of a nonremovable plaster of paris cast that selectively immobilizes proximal joints in an ideal position while constraining distal joints to direct desired motion over a long period. This uses active motion only. Traditional hand therapy techniques or modalities are not used. This treatment approach was beneficial to the patient as a minimum of 2 appointments per month were needed to regain functional hand use., Purpose of the Study: To document the use of the CMMS technique as an effective treatment approach in the management of a crush and degloving injury of the hand., Methods: The CMMS technique was applied to the patient's left (nondominant) hand 8 weeks after injury. The technique's aim was to improve the 30° flexion deformity of the left wrist and flexion contractures of the index, middle, and ring fingers with a total active motion of 0°. Orthotic devices and traditional therapy were applied once joint stiffness was resolved, and a normal pattern of motion was reinstated., Results: At 6 months, substantial improvement was noted in wrist as well as metacarpophalangeal and interphalangeal joints. Total active motion exceeded 170° in all fingers excellent functional outcome resulted as measured with the upper limb functional index short form-10. The upper limb functional index increased from 0% to 55% of preinjury status (or capacity) over the 18 months of therapy., Discussion: Brief immobilization through casting causes certain functional losses, but these are temporary and reversible., Conclusion: Finger stiffness, edema, and tissue fibrosis were successfully managed with the CMMS technique without the need for attendance at multiple hand therapy sessions., Level of Evidence: Level V., (Copyright © 2016 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.)

Morel-Lavallee lesion is a closed degloving soft tissue injury in which subcutaneous tissue is torn from the underlying muscular fascia. The tear leads to venolymphatic leak, and concomitant adipose tissue necrosis from the force of the trauma causes swelling and possible infection at the site of injury. The traditional treatment for the lesion is surgical drainage and debridement. In this report, an endoscopic method is described, which achieves the goal of an open surgical debridement but minimizes surgical morbidity., (Copyright © 2016 Elsevier Ltd. All rights reserved.)