Citations 2
Operative Strategies and Wound Complications for Morel-Lavallee Injuries Undergoing Excisional Debridement: A Pacific Coast Surgical Association Multicenter Study
Nguyen, Peter , Grigorian, Areg , Costantini, Todd, Santorelli, Jarrett, Husen, Lilian Von, Inaba, Kenji, Schellenberg, Morgan, Stephens, Daniel, Chaar, Mohamad Abou, Mahmoud, Khalid, Schreiber, Martin, Minoza, Karen, Underwood, Samantha, Biffl, Walter, Lü, Ning , Bayat, Dunya, Edwards, Sara, Tillou, Areti, Zheng, Dennis J. , Plevin, Rebecca E. , Stein, Deborah, Smith, Juliana, Sonntag, Cheyenne C., Callcut, Rachael A. , Furlong, Harly, Graeff, Leonardo Weber, Trevizo, Eric, Cochran-Yu, Meghan, Duncan, Thomas, Diaz, Graal , Neville, Angela , Balan, Naveen , Siletz, Anaar, Ley, Eric, Park, Greigory, Alexander, Juliet, Johnson, Arianne, Cotton-Betteridge, Aaron , Smith, Maren, Alvarez, Claudia, Scolaro, John, Aryan, Negaar , Nahmias, Jeffry, Nguyen, Peter D , Abou Chaar, Mohamad , Lu, Ning , Coimbra, Raul , Balan, Naveen , Alvarez, Claudia , Aryan, Negaar , Costantini, Todd W. , Dilday, Joshua C. , Inaba, Kenji , Schellenberg, Morgan A. , Stephens, Daniel, Chaar, Mohamad K. Abou , Minoza, Karen , Biffl, Walter L. , Tillou, Areti , Kim, Hannah , Graeff, Leonardo W., Duncan, Thomas K. , Kim, Dennis S. , Siletz, Anaar E., Ley, Eric J. , Scolaro, John A. , Nahmias, Jeffry T.
The American Surgeon™ | April 16, 2026 | Volume: No volume available | Issue: No issue available | Pages: No page available
Morel-Lavallee lesions (MLLs) are traumatic closed degloving injuries with operative intervention (OI), especially excisional debridement, remaining the mainstay of treatment. However, high-quality evidence describing operative techniques and outcomes remains limited. This study aimed to characterize current OI practices and associated outcomes, especially among patients undergoing excisional debridement, hypothesizing an increased risk of wound complications with this approach for MLLs. Methods This prospective (2021-2024), multicenter, observational study was conducted across 15 trauma centers and included patients diagnosed with MLL who underwent OI. The association between operative technique (eg, excisional debridement) and the primary outcome of wound complications was evaluated. Wound complications were defined as cellulitis, deep wound infection, skin necrosis, necrotizing soft tissue infection (NSTI), and/or organized hematoma. Results Of 88 MLL patients undergoing OI, 36 (40.9%) had excisional debridement, with 4 (11.1%) limited excision to skin, 20 (55.6%) extended to subcutaneous tissue, and 12 (33.3%) down to muscle. Excisional debridement had higher rates of skin necrosis (22.2% vs. 1.9%, P = .002). Although overall rates of wound complications were statistically similar between cohorts (33.3% vs. 17.3%, P = .098), univariate analysis demonstrated excisional debridement had increased risk of wound complications (OR 2.52, CI 1.07-5.97, P = .035). Conclusion This prospective multicenter study over three years demonstrated that a fifth of MLLs undergoing excisional debridement developed postoperative skin necrosis. Excisional debridement also had a more than two-fold increased risk of wound complications compared to other OIs. These findings underscore the importance of investigating alternative operative techniques, such as incision and drainage or minimally invasive debridement methods.
Lost fractures: prevalence and risk factors for missed costosternal and costal cartilage fractures among patients with radiologic chest wall injury
Forrester, Joseph D , Chaar, Mohamad Abou, Barnes, Andrew T, Bauman, Zachary M, Bendjemil, Samy, Betts, Nizama N, Christie, Benjamin, Dasari, Raaga, WB, Devoe, Earley, Michelle J., Faliks, Bradley , Johns, Tracy J, Johnson, Connie, Junker, Michelle S., Kim, B. D., King, Jonathan, Knight, Ariel W. , Schweibinz, Alexis, Stephens, Daniel, Stuever, Mary, Wang, Simeng , Forrester, Joseph D. , Chaar, Mohamad K. Abou , Stephens, Daniel , Abou Chaar, Mohamad , Kim, Brian D. , King, Jonathan M , Knight, Ariel Whitney , Bauman, Zachary Mitchel , DeVoe, William B. , Johns, Tracy J. , Stuever, Mary
Trauma Surgery & Acute Care Open | January 9, 2026 | Volume: 11 | Issue: 1 | Pages: e002020
Background Costosternal cartilages and the costal margin, collectively termed costal cartilage, are hyaline cartilage connecting ribs to the sternum and to adjacent ribs, respectively. Presence of intact costal cartilage is essential for elasticity of the chest wall. Anecdotally, costal cartilage injuries are underdiagnosed on trauma CT scan in patients with rib fractures. Our aim was to determine a baseline frequency of acute costal cartilage injury among patients presenting with rib fractures. Methods We performed a retrospective cohort study of injured adult patients admitted to Level I/II trauma centers with rib fractures from January 2020 to July 2024. CT images obtained at admission were manually reviewed by chest wall surgeons for presence of costal cartilage injury. Concordance with the original radiology report was obtained. Multivariable regression was used to analyze factors associated with costal cartilage injury and missed cartilage fractures. Results 1441 patients were identified; 197 (14%) had a costal cartilage fracture. A plurality of injuries included falls (n=667, 46%). Median ISS (Injury Severity Score) was 13 (IQR: 9 to 21), median Abbreviated Injury Scale thorax score was 3 (IQR: 3 to 3), and median number of fractured ribs was 3 (IQR: 3 to 7). 294 (21%) patients had radiographic flail segments, and 136 (9%) had sternal fractures. 172 (87%) patients had a costal cartilage fracture missed on initial trauma chest CT. On multivariable analysis, ISS (adjusted OR (aOR) 1.02 (95% CI 1.01 to 1.04), radiographic flail segment (aOR 1.6 (95% CI 1.10 to 2.31)) and presence of sternal fracture (aOR 1.85 (95% CI 1.19 to 2.89)) were associated with costal cartilage fractures. Only the total number of rib fractures was associated with a missed costal cartilage fracture on univariate analysis (OR 1.17 (95% CI 1.01 to 1.36)). Conclusions Costal cartilage injuries are common and frequently are not identified during interpretation of the initial trauma CT. A higher index of suspicion is warranted for costal cartilage fractures among patients with greater injury burden, radiographic flail segment, and sternal fractures. Level of evidence Level III.