Large Lumbosacral Morel-Lavallée Lesion in a Polytrauma Patient: A Case Report on the Failure of Percutaneous Sclerotherapy and Resolution After Catheter Drainage

We report a large lumbosacral Morel-Lavallée lesion, a closed degloving injury in which shear separates the skin and subcutaneous fat from the deep fascia, in a polytrauma patient in whom the diagnosis was delayed by 25 days and percutaneous sclerotherapy twice failed before the collection resolved with catheter drainage.A 31-year-old man was ejected from a vehicle in a high-speed rollover and sustained a severe traumatic brain injury among multiple other injuries.His admission trauma computed tomography (CT) showed a dorsal subcutaneous hematoma from the coccyx to T12, read as a simple hematoma and unremarked on a repeat scan three days later.He was deeply sedated, lay supine on the lesion, and had the overlying abrasions under occlusive dressings.On day 25, a large fluctuant swelling was found over his right flank and buttock, and CT showed a subcutaneous collection of at least 194 × 47 × 103 mm crossing the midline.Ultrasound-guided aspiration yielded 590 mL on day 30, followed by sclerotherapy with sodium tetradecyl sulfate (Fibrovein; STD Pharmaceutical Products, Hereford, UK), and 700 mL on day 40, followed by sclerotherapy with ethanol.The catheter was removed at the end of each procedure, and the collection recurred within days on both occasions.At a third procedure on day 46, 400 mL was aspirated, and a 12-French pigtail catheter was left in place; it was accidentally dislodged after three days, but the collection did not return.All aspirates were sterile, and the site remained clinically resolved at two months.Recognition was delayed because a severe brain injury and prolonged sedation left him unable to report pain or swelling.Both recurrences followed procedures in which no catheter was left in the cavity, over a site where effective compression could not be maintained in a bedbound patient, and these factors may have contributed to the failure of sclerotherapy.