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.
Early vs Late Surgical Intervention for Morel-Lavallée Injuries: A Pacific Coast Surgical Association Prospective Multicenter Study
Smith, Maren, Grigorian, Areg , Santorelli, Jarrett , Stephens, Daniel J, Minoza, Karen , Biffl, Walter L, Tillou, Areti , Nahmias, Jeffry, Group, the Morel-Lavallee Study, Balan, Naveen , Balan, Naveen , Dilday, Joshua C. , Biffl, Walter L. , Coimbra, Raul , Nahmias, Jeffry T.
Journal of the American College of Surgeons | March 12, 2026 | Volume: 243 | Issue: 3 | Pages: 651-659
BACKGROUND: Morel-Lavallée lesions (MLLs) are closed degloving injuries that occur throughout the body and present treatment challenges due to their rarity and variability in management. We aimed to compare characteristics and outcomes for MLL patients undergoing early (less than 48 hours) vs late (more than 48 hours) surgical intervention, hypothesizing decreased length of stay (LOS) with early intervention. STUDY DESIGN: Fifteen centers participated in this prospective observational study, including all adult patients who sustained a MLL and underwent surgery. No patients were excluded. Bivariate comparisons for early vs late intervention cohorts were performed. RESULTS: Of 150 MLL patients, 101 (67.3%) underwent early intervention. Both cohorts had comparable ages, BMI, vitals, Charlson Comorbidity Index, and injury severity scores (all p > 0.05). However, early intervention patients more commonly had abdominal (37% vs 6.3%, p < 0.001) MLLs, whereas late intervention patients more often had hip (16.7% vs 3.0%, p = 0.01) and thigh (41.7% vs 22%, p = 0.03) MLLs. Early patients had shorter ICU LOS (2 vs 5, p = 0.003) but statistically similar hospital LOS (12 vs 20, p = 0.06). There was no difference in wound-related complications (19.8% vs 24.5%, p = 0.51) or mean number of additional surgeries (p = 0.41) between cohorts. CONCLUSIONS: Over two-thirds of MLL patients underwent early operation. These patients had decreased ICU LOS and a statistically similar albeit clinically shorter overall LOS, despite similar demographics, comorbidities, injury severity, and number of additional surgeries. Therefore, early operation appears beneficial and should be pursued in MLL patients when clinically indicated and feasible.