Rare Neonate Morel-Lavallee Injury: A Case Study

Morel-Lavallée lesion is a rare condition that was described by the French physician Maurice Morel-Lavallée in 1853. This case study illustrates this in an unlikely age group. 

A one month old was transferred to a Pediatric Trauma Center for a non-accidental trauma.  The patient presented pale with poor capillary refill, multiple areas of ecchymosis over buttocks and left flank, and initial hemoglobin of 5.3.  Parents reported the infant was carried down a flight of stairs by her 230lb father who fell, landing directly on his daughter.  Radiology review revealed sustained bilateral pubic rami fractures and a large left subcutaneous hematoma extending from superior left chest into the left back and buttock.  She was taken to the OR day 1 for incision and drainage of the hematoma, wound debridement and Negative Pressure Wound Therapy (NPWT) placement.  The wound was 5x2cm tunneling in multiple directions near the spine.  The NPWT was changed weekly with the dressing placed thin and lightly into wound as a wick avoiding probing or excessive pressure.  Child protection team consult concurred the injuries were consistent with the story.  The patient was transferred to a rehabilitation center on day 14 for wound care.  The wound size decreased and was discontinued after 60 days when the subcutaneous tissue and muscle were fused together.

The Morel-Lavallée lesion is caused by shear injuries when the skin and subcutaneous fat sheer away from the underlying fascia. It leads to a hollow space which fills with blood and lymph fluid from the perforating vessels and severed lymphatic channels.  This leads to fat necrosis. In some cases the mass may be surrounded by a capsule that is indicative of a lesion requiring surgical intervention.  Conservative treatments such as compression may be refractory.  Treatment options are controversial and can include compression garments, surgical drainage, resection and NPWT.