In part 3 of this entry, I’ll describe the exact nature of the accident and my experience directly afterward. I wanted to place a little emphasis on how I felt and the sensations I experienced after the accident as well.
I wanted to also warn some readers that the pictures are a little graphic, but I didn’t want to leave anything out. As everyone now probably knows, On September 26th, 2009, I sustained a traumatic injury after a bicycle accident. The accident occurred in a 65 mile ride around the bay in Corpus Christi, Texas. This story and information is not really about the race and how the accident occurred, but rather about the aftermath of the injury and the experience of having a large hematoma or Morel-Lavallee’ lesion and how I treated it.
Directly after the accident, I got up to check my injuries. These included local lacerations to my right eye orbit and a lot of scraps, bruises and ‘road rash’. I actually tried to get back on my bike and then realized my front carbon fork was cracked. So the ride was over. A passerby stopped after the accident and had ice and some local bandages. At the time, we were more concerned with stopping the bleeding over my right eye that I actually ignored the hip injury. So, we began applying ice almost immediately to my right eye.
I had my racing bib on and noticed some pain after about 20 minutes to my left thigh. When I looked down, all I could see was a lot of road rash and some bleeding, but no actual swelling that was severe. I was picked up and dropped off my bike at the bike shop before going home.
When at home, I took a bath and went over all my injuries. The road rash to my right thigh was now beginning to get sore. This was probably about 1.5 hours after the accident. My wife began to get concerned, so she coaxed me to go to the local emergency room. When we arrived at the ER, I called one of my friends to get looked over. The ER doctor basically told me to continue icing and a tight compression wrap was applied to my thigh. (Figs.1)
Figure 1 Initial presentation at injury.
I then went home and noticed it was starting to get harder to walk and put pressure down on my left leg. It was now about 3 hours after the accident. I then sat on my couch and began icing the thigh through the tight bandage. It was at this moment, that I began to experience a lot of pain including a stinging sensation and increased swelling directly over my tronchanter of my left femur. I began to loosen the compression wrap and noticed increased tissue swelling and dissection of the hematoma in a circular pattern around the initial injury spot. This hematoma dissection and swelling was extremely painful. Fear of not knowing how swollen this was getting, it prompted me to head back to the emergency room after only about an hour since I was discharged.
When I got to the ER, It was then that the doctor suggested I be admitted for observation. This was a welcomed relief for me because they then started an IV and gave me Morphine. The pain was much more tolerable at that point. The orthopaedic surgeon then examined me once I was admitted and he could already see that the hematoma forming would likely have to be drained at some point and time. He suggested we not drain it initially because of the skin abrasions for fear of possible infection. So, in the hospital, I was placed on IV fluids and given pain medication. No antibiotics were given in the hospital. I was discharged the next day and given pain pills and some oral antibiotics for 14 days.
I found it still very difficult to walk the next day and my entire thigh was also very swollen, so I continued to walk on crutches. I actually walked on crutches for about 3 days and then I could walk again, but with a noticeable limp. Getting in and out of the car was a challenge and I had to have my wife help me put on my socks in the morning. It took about a week before I could actually start putting on my own socks. This was because it took about a week before I could bend my knee comfortably. This was in part due to the hematoma and some knee effusion or swelling.
Every day, I washed the road rash and the hematoma region with clean soap and water and applied an antibiotic ointment with bandages to the dressing. I covered the gauze dressings with an ace wrap for compression. I did this for about 7 days. Once the road rash was healed, I stopped using the antibiotic ointment dressings, but continued to use the ace for compression. It was about this time, 7-8 days after the accident, that I couldn’t keep on the ace wrap anymore. The ace would just roll over the hematoma. This was probably due to the swelling of my entire thigh going down.
A few days after the accident, there were a few others suprises that occurred. First, my groin began to hurt and I noticed from days 7 to 15, I had lymphadenopathy. Lymphadenopathy is a swelling that one gets, in this case, along the groin. Here, there is a rich supply of lymph nodes. Lymph plays an important part in the immune system and helps to filter out debris and are rich in white blood cells. When you begin to fight off infections, the lymph glands or nodes start producing more lymph fluid to help circulate immune cells to help fight off infection, among other things. I suspect that the hematoma was causing inflammatory conditions that activated and over worked my lymphatics to fight off infection as well as help stabilize the hematoma. Also, my entire pelvis turned to a dark color purple!
An MRI was performed on the 5th day after the accident where it already showed good consolidation of the hematoma. (Fig. 2) It was already beginning to get well encapsulated. The hematoma was now consolidating into a firmer mass with a surrounding firm periphery to the mass. I saw the Orthopedist on the 9th day and he scheduled me for surgery (which was to be on the 13th day after the accident). Unfortunately, a scheduling conflict caused a rescheduling of the surgery until the following week, which would make it about 20 days since the accident.
Figure 2 MRI of classic Morel-Lavallee’ lesion.
I will tell you , that I was ready to have the thing drained by the 2nd week. After 13 days, there was a definite change in the hematoma periphery. It was getting much firmer and more encapsulated and more painful. I began to think at that point, that drainage is better within the first 2 weeks than later. In fact, there have been a number of articles written that suggests the more encapsulated a Morel-Lavallee’ lesion gets, the more likelihood of forming a denser capsule and causing reaccumulation of seroma or recurrent hematoma.
The extra week I had to wait for surgery was frustrating. I continued to have trouble sleeping and turning. I could only lay on my back and right side. In the evenings, the now well encapsulated hematoma would swell and hurt. I was ready for the drainage and it couldn’t come any quicker.
Luckily, my surgery was performed exactly 20 days since the accident.
The Series
Part 1 – Anatomy of a Bicycle Crash
Part 2 – Morel-Lavallee’ Lesion or Traumatic Hematoma after a Bicyle Accident
Part 3 – Morel-Lavalle’ Lesion – The Aftermath
Part 4 – Morel-Lavalle’ Lesion – The Surgery
