Doxycycline sclerodesis as a treatment option for persistent Morel-Lavallée lesions

Abstract

Introduction: Morel-Lavallée lesion is a rare cause of subcutaneous swelling, caused by post-traumatic shearing of the hypodermis from the underlying fascia. Treatment of such lesions is still not well established.

Objective: To evaluate the results of conservative treatment for these lesions using doxycycline induced sclerodesis followed by elastic compression bandaging.

Patients and methods: We treated 16 Morel-Lavallée lesions between May 2005 and December 2008. These lesions developed in 13 male and 3 female patients (mean age 41 years; range 10-74 years) due to various modes of trauma. The lesion involved the thigh region in 13 patients with trochanteric region, gluteal, lower back, and lower abdominal wall being other regions involved. An area of palpable fluctuance was the most consistent examination finding. Treatment was effected by fluid aspiration, doxycycline instillation, and compressive elastic bandaging. Healing was defined as the loss of fluctuation with complete absence of fluid on ultrasonography.

Results: The average duration of the persistence of the lesion was 13 months (range, 6-23 months). Most of the lesions had been aspirated previously multiple number of times, average being 3.44 times (range, 1-6 times). All lesions were aspirated and found to be negative on culture. The mean follow up period was 50.44 months (range, 31-74 months). 11 patients showed complete resolution of fluid collection at 4 weeks with another 4 patients resolving at 8 weeks follow up. The lesion persisted in one patient at 12 weeks due to non-compliance to compressive elastic bandaging which subsequently resolved on repeating the procedure. All the lesions healed without any infections or necrosis. No recurrences were detected during the follow up period. A persistent non-fluctuant contour deformity, decreased skin mobility over the site of lesion, and feeling of tightness were the most common problems faced on long term follow up.

Conclusion: Closed degloving injuries can be managed satisfactorily with doxycycline induced obliteration of the cavity with early healing time without recurrences.