(CS-133) Management of Morel-Lavallee Lesion After Pelvic Internal Fixation Using Ultra-Thick, Cryopreserved Human Amniotic Membrane Allograft

Introduction: Pelvic ring injuries are commonly observed following high-energy trauma and are generally managed with internal or external skeletal fixation.^{1, 2} Although relatively uncommon, Morel-Lavallee Lesions (MLLs) are closed, degloving injuries that most frequently occur near the pelvis and generally appear within days following the traumatic injury. These lesions are challenging to manage and are a significant risk factor for surgical site infection near the initial repair.^{3, 4} As a result, incision sites can break down and lead to large, complex wounds that are difficult to heal. Herein we describe the use of ultra-thick, cryopreserved human amniotic membrane (AM) allografts to expedite wound healing and mitigate complications.^5-7

Methods:

Case report of a patient who was treated with AM allografts† for MLL and an infected surgical wound following internal fixation of the posterior pelvis.

Results:

A 24-year-old female involved in a motor vehicle accident presented with pelvic ring disruption, bladder rupture, pulmonary contusion, and rib fractures. Pelvic embolization was performed, followed by internal and external fixation of the posterior and anterior pelvis one day later, at which time, a posterior MLL was noted. Multiple incision and drainage procedures were performed, and the posterior incision was noted to be macerated and draining with eschar at day 7. External fixation was removed in the OR on day 14. By Day 17, patient presented with a large wound measuring 18x6.5x4cm in size (468 cm³) with positive culture of Enterobacter aerogenes and E. cloacae. Intravenous antibiotics were administered along with negative pressure and dressings. Antibiotic beads and AM allografts were placed on Day 20, and the wound reduced to 8.5x9x2.5cm (191 cm³) within 7 days. Incision and drainage was performed again at 6 weeks followed by a second application of AM. At 4 months, the patient was ambulating normally and resumed physical activity with progressive wound epithelialization. By 7.5 months, the wound completely epithelialized.

Discussion:

In summary, use of AM allograft was shown to support wound closure in the treatment of an infected Morel-Lavallee Lesion following pelvic internal fixation.

Trademarked Items:

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