Operative Strategies and Wound Complications for Morel-Lavallee Injuries Undergoing Excisional Debridement: A Pacific Coast Surgical Association Multicenter Study.
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Nguyen Peter D, Grigorian Areg, Costantini Todd, Santorelli Jarrett, Von Husen Lilian, Dilday Joshua, Inaba Kenji, Schellenberg Morgan, Stephens Daniel, Abou Chaar Mohamad, Mahmoud Khalid, Schreiber Martin, Minoza Karen, Underwood Samantha, Biffl Walter, Lu Ning, Bayat Dunya, Coimbra Raul, Edwards Sara, Tillou Areti, Zheng Dennis J, Plevin Rebecca E, Kim Hannah, Stein Deborah, Smith Juliana, Sonntag Cheyenne C, Callcut Rachael, Furlong Harly, Graeff Leonardo Weber, Trevizo Eric, Cochran-Yu Meghan, Duncan Thomas, Diaz Graal, Kim Dennis, 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
Аннотация
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.MethodsThis 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.ResultsOf 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).ConclusionThis 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.