Postoperative outcomes of Morel-Lavallee injuries and predictive factors for wound complications: A Pacific Coast Surgical Association multicenter study

Background Morel-Lavallee lesions are traumatic closed degloving injuries. Operative intervention remains the primary treatment approach. However, high-quality postoperative outcomes data are limited. This study aimed to determine the rate of wound complications associated with Morel-Lavallee lesions and identify risk factors for postoperative wound complications. Methods A prospective, multicenter, observational study (2021-2024) was conducted across 15 trauma centers. Adult patients with a Morel-Lavallee lesion who underwent operative management were included. The primary outcome was incidence of wound complications, defined as cellulitis, deep wound infection, skin necrosis, necrotizing soft tissue infection, and organized hematoma. Multivariable logistic regression was performed to identify predictors of wound complications. Results Among 134 patients who underwent operative intervention for Morel-Lavallee lesions, 27 (20.1%) developed a postoperative wound complication. Wound complications included skin necrosis (n = 10, 7.5%), deep wound infection (n = 9, 6.7%), cellulitis (n = 7, 5.2%), organized hematoma (n = 7, 5.2%), and necrotizing soft tissue infection (n = 3, 2.2%). In patients with wound complications, more frequent mechanisms of injury were bicycle collision (14.8% vs. 1.9%, P =.004) and pedestrian struck by motor vehicle (37.0% vs. 15.0%, P =.010). On multivariable analysis, only pedestrian struck by motor vehicle mechanism of injury (odds ratio 3.44, 95% CI 1.29-9.17, P =.014) was an independent predictor of increased wound complications when also controlling for closure of dead space, current tobacco use, and diabetes. Conclusion More than one fifth of patients undergoing operative management of Morel-Lavallee lesions developed a postoperative wound complication. The only independent predictor of wound complications was pedestrian struck by motor vehicle mechanism of injury. These findings may help guide patient counseling.