Chronic Morel-Lavallée Lesion Treated With Percutaneous Ultrasonic Debridement.

Abstract

Morel-Lavallée lesion is defined as an internal degloving injury. A trauma involving shearing forces causes separation of the superficial fascia from the overlying subcutaneous tissue and skin, creating a potential space for hemolymphatic fluid to accumulate. This leads to the development of a self-resolving or potentially chronic collection. Classically, lesions arise in the lateral thigh. Imaging features depend on the duration of the lesion. Acutely, ultrasound and MR imaging will demonstrate a hematoma-like mass that is parallel to the underlying fascia. As the lesion evolves over time, calcifications with a dense capsule can form. Patients typically present with a persistent, localized swelling and pain that may radiate throughout the thigh. Initially, conservative therapy can be efficient; however, once a capsule forms, surgical management is the current gold standard therapy. Tenex (Tenex Health, Lake Forest, CA) is a device that uses high-frequency ultrasonic waves to perform percutaneous debridement to disrupt and remove calcifications in the setting of various chronic musculoskeletal conditions. This case describes the successful use of this technology in a 68-year-old female with a 10-year history of a Morel-Lavallée lesion. Treatment of Morel-Lavallée lesions using the Tenex device is a feasible, minimally invasive alternative to conventional surgery.