Morel-Lavallée Degloving Injury of the Thigh with NPWT and Delayed STSG
Management of a high-energy thigh degloving with underlying Morel-Lavallée lesion, serial débridement, negative-pressure wound therapy, and definitive split-thickness grafting.
Patient Information
- Age: 30 years
- Gender: Male
- Diagnosis: Closed degloving injury (Morel-Lavallée) of the anterolateral thigh with large skin avulsion and underlying haematoma after road traffic accident
Procedure
Evacuation of haematoma, extensive débridement of non-viable fat and skin, VAC therapy, and delayed STSG once wound bed optimised.
Findings
Large fluctuant zone over lateral thigh with skin avulsion but no open fracture. MRI suggested Morel-Lavallée cavity with liquefied haematoma and shearing of subcutaneous tissue from fascia. Initial exploration evacuated 400 mL organised haematoma; overlying skin paddle demonstrated marginal viability.
Surgical Technique
First surgery: incision and drainage, excision of non-viable fat, insertion of NPWT at 125 mmHg continuous. Serial dressing changes with progressive débridement of necrotic adipose tissue. At day 12, wound bed granulating with 100% granulation tissue over fascia; defect 22 × 14 cm. STSG harvested from contralateral thigh (0.014 inch), meshed 1:2, stapled and bolstered. Post-graft limb positioning to minimise shear.
Outcome
Graft take 90% with small area of proximal delay healing by secondary intention. No deep infection. At 10 weeks, patient returned to desk work; at 4 months, resumed light activity with compression garment for contour management.
Clinical Notes
Degloving injuries are often under-resuscitated in initial trauma assessment; delayed grafting after VAC optimisation improved graft survival compared with immediate grafting over contaminated fat.