Surgery to decompress the lesion couldn’t come fast enough. The week prior, we had surgery scheduled, but due to a scheduling conflict, the surgery was postponed for a week. This week before surgery was probably the toughest. The periphery of the lesion was getting harder and it proved a challenge to sleep at night. Every time I turned in bed, I would wake up from the pressure on the hip. Since surgery was scheduled that Friday, then resecheduled, I planned to make the most of the weekend and visit Chris in Victoria and get in some hunting at the ranch. I figured I would just sit in the deer blind and rest it out. The hunt went well, we shot 1 buck and 2 doe on his management ranch. I probably did a little more than I should have, because in the evenings, my hip almost appeared to swell a little and get a little bigger.
I returned home, processed the meat and then went back to work from Monday to Thursday. I even managed to mow the lawn on Thursday so I didn’t have anything to do after the surgery, but just rest. On Friday, October 16th, I underwent the decompression. The following pictures are kind of gross, but I have to include them for completeness.
The surgery was planned as an out-patient procedure, so I went home directly after the surgery. I propped myself up on the couch and was glad to have my hip now completely flattened. In fact, it didn’t even hurt. After the surgery, I had an ace compression wrap around my hip and a Jackson-Pratt drain. Within the first 12 hours, I already had over 100cc’s of fluid coming out of the drain, then I drained that Friday night.
The next day, on Saturday, I had another 50 cc’s in the drain. Then something unexpected happened. It began to swell and fill with blood again. This was painful, so I called the surgeon, who lived pretty close. I felt bad about calling him on a Saturday, but I didn’t feel I had much choice. He came over and noticed the ‘fresh’ blood coming out of the Jackson-Pratt drain. He tried to unclog the drain by milking the tubing, but unfortunately, this didn’t work. The drain was clogged. He unwrapped the dressing and we noticed bleeding from the incision site. He recommended we go back to surgery that day and open the area up more and apply negative pressure against the wound to allow the wound the drain.
We returned back to surgery on Saturday and the wound VAC was applied. This completely decompressed the area and kept it ‘flat’ with negative pressure applied to the area. He did have to open the wound a little bit more. He stated he tried to cauterize some of the bleeders to the flap and he also packed in some gel-foam. This would help also prevent recurrent bleeding. On Monday, I went back to surgery to have the wound VAC changed. Everything went very nicely throughout the week.
On Thursday, I had the wound VAC changed at bedside (more pictures later). The wound looked good and very little drainage was coming from the VAC the past few days. The doctor recommended I wear the VAC for an additional week to ensure proper healing and make sure the defect did not try to fill back up with blood. As of now, the area is healing beautifully and I think the worst is behind me.
I think in retrospect, if you have this type of lesion and have it drained, be sure to have a wound VAC applied directly to the area to promote negative pressure drainage and possibly prevent a return to surgery to have the area decompressed a second time.
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
Glad you are better. The orthopods in San Antonio (BAMC) were big into wound vacs. Barb had one in for her hip surgery for quite a while. They felt strongly about how they help wound healing.
BTW the same orthopods were very impressed by the bunion surgery that you did on Barb. They commented on how well it was done! Thanx.
Get well soon.
Thx for the very nice compliment. I am getting much better. I’ll have the VAC on for another week before I have it removed.
I am currently suffering from a Morel-Lavalle lesions (MLL) as result of a motor vehicle crash. My MLL are in the exact same area and looks very very similar to the woman’s MLL in your photos. I can relate too well to the sleeping on your back to avoid the pressure. I saw a plastic surgeon today and he suggest ultrasound aspiration oppose to surgery. He said it may fill back up with fluid or it may not. I guess we just have to wait and see.
Thanx for posting this information, it was very helpful!
BTW – my accident was Oct 17th and the MLL have been growing since I left the hospital.
Interesting page. I have had this condition for over 10 years, since a ski accident. I have had it aspirated a number of times, including once unintentionally when it ruptured during athletics. It always comes back. I have finally grown tired enough of it and surgery to have the whole thing removed is planned. It took a loooooong time to get any kind of diagnosis. Three MRIs, CT, Ultrasound – only on the 3rd most recent MRI did the radiologist identify it as Morel-Lavallee.
For your surgery, it looks like they lanced it and then had it drained.
I think using the KCI wound vac did the trick. I still have some scar tissue, but it has not come back.
Great write up!
Suffering the same following a motorcycle accident three months ago. They tried needle aspiration about 3 weeks ago now and only got 80mls out of it but still a sizeable lump and swelling. First MRI confirmed MLL, they are talking surgery at the moment. Back in with ortho in early December.
Few Qs, would really appreciate it if you could let me know.
How long did you have vac on for?
What was the recovery time like following surgery? just wondering how long i could expect to be out of work…. I know they are not all the same but seems similar to yours… mine prob a bit deeper. No obvious discoloration of skin but swelling is clear.
Presume it was done under local anesthetic?
How did the scar finish out? One thing the doctors mentioned is that they can be very trick to stitch because the skin has stretched.
Much appreciated!.
Ken.
It’s been over a year now, won a race last year and the leg is doing well. I still have some numbness and very little scarring. I suggest anyone who has this, have it opened and a wound VAC placed. It will save you a lot of headache down the road.
Excellent write up on a condition not well documented even on the net.The problem is that in the first few days the blood under the skin clots and is difficult to aspirate. One method suggested was to use a 50ml syringe with a lareg bore ( 16G) IV introduction needle ( Jelco). The needle is inserted obliquly into the clot while connected to the 50cc syringe. The syring plinger is drawn back creating a negative pressure. If the blood does not flow easily into the syringe then a 2cc syringe is wedged inot the barrel of the 50cc syringe against the plunger i.e. it holds the 50cc syringe plunger in place maintaining negative pressure. The needle is then moved back and forth and around breaking up the clot while aspirating at the same time i.e. just like liposuction. Once the clot is removed ( takes 5 to 10 mins) then a pressure banadage is applied. This apparently gives good results especially for the ones that are tense and threatwening to damage the skin. If however the lesion is older i.e. few weeks to months or even years then surgical debridement of the lesion , possible intralesional suturing and drains are needed. A suction drian is probably the best and should probably be left in for at least 2 to 5 days… There’s a research paper in this for someone as the literature is minimal and opinions devided.
Cheers Paul for the details,
8 weeks now since my original aspiration. Got 80ml out but hardly really scratched the surface. Booked in for another aspiration next week and after that referral to plastics to take a more invasive approach.
Personally I just want to get the bloody thing sorted!
Paul, I get the impression that you’re in the medical arena?
Ken, I would suggest just having the thing opened and drained with negative pressure applied. GL
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