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Novel Use of a Closed Liposuction System: Treatment of an Acute Morel-Lavallée Lesion of the Upper Extremity
Anooj Patel BS, Corinne Wee MD, Anand Kumar MD, Donald Harvey MD
University Hospital Case Western Reserve University School of Medicine
2020-01-29
Presenter: Anooj Patel
Affidavit:
This work represents the original work of Anooj Patel. I approve the submission as indicated by my signature below.
Director Name: Anand Kumar
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Hand
Background: Morel-Lavallée lesion (MLL) is a closed post-traumatic soft tissue degloving injury resulting in tissue loss. Current treatment options for MLL include open irrigation and debridement and percutaneous drainage. A few cases of suction assisted lipectomy (SAL) have been described. We present the first case report of using a closed SAL system to treat MLL.
Methods: A seventy-eight year-old female with right forearm MLL presented after blunt force trauma while on apixaban. After inpatient monitoring and anticoagulant drug clearance closed system SAL was performed to clear the hematoma and prevent ischemia of overlying soft tissues. A closed system provides a constant 300-mmHg vacuum pressure compared to commonly higher and variable negative pressures with standard liposuction. Treatment outcomes were measured by clinical exam, patient-reported symptoms, and CT imaging.
Results: Pre-operative diagnostic CT scan demonstrated a 4.8x6.6x13cm fluid collection between fascial layers of the right forearm. SAL resulted in the evacuation of 300cc of coagulated blood. Post-operative CT imaging did not show any measurable fluid collection. Clinical exam demonstrated resolution of swelling and soft tissue compromise. The patient reported significant pain reduction, resumed her anticoagulation, and was discharged home. There were no notable complications at her three month post-operative visit.
Conclusion: SAL is an effective treatment for acute MLL. Consideration to a constant low pressure SAL system can prevent further trauma to the injured soft tissues. SAL allows for the evacuation of blood with less disturbance to overlying tissues and faster healing time when compared to open debridement.
