Morel-Lavallee Lesion: A Case Report

PURPOSE: Morel-Lavallee lesions is post-traumatic effusion at subcutaneous layer. Early management of Morel-Lavallee lesion is percutaneous drainage and compression. Surgical excision is recommended for cases that are chronic. METHODS: A 41-year old male patient had slow growing, painful mass on left thigh, which has been present for 3 years. He had a history of blunt trauma 3 years ago. Computed tomography presented 10 x 10 x 5 cm sized cystic mass on left thigh, between subcutaneous fat layer and muscle fascia layer. The mass was surgically removed and biopsy was performed. RESULTS: Histopathological examination shows chronic inflammation and fibrotic change. After 6 month follow-up period, postoperative course was uneventful. CONCLUSION: We performed surgical excision of Morel-Lavalle lesion in a patient who had trauma 3 years ago. We report a case of Morel-Lavallee lesion with the review of the literatures.

Posteromedial Thigh Perforator Flap: An Anatomical Study and Clinical Applications

PURPOSE: An anatomical study concerning the location of the perforators to the posteromedial thigh perforator flap was done for the purpose of clinical application, and reconstruction using this flap was undergone for 3 patients with ischial sores. METHODS: The authors dissected 6 cadavers, measuring the distance between the perforator of the posteromedial thigh perforator flap and the extended line of the inguinal crease. The location of the perforator was studied using this data. In the 3 cases mentioned above, perforators were traced using Doppler ultrasonography and the sores were reconstructed with posteromedial thigh perforator flaps. Anatomical study results showed that posteromedial thigh perforators were found 77+/-18.9mm below the extended line of the inguinal crease. Application of the flap in the 3 patients was successful. CONCLUSION: The perforator to the posteromedial thigh perforator flap was found to be located in a relatively consistent position. Since this flap is also comparatively easy to elevate and mobilize, and shows low donor site morbidity, it is considered to be very useful in the treatment of ischial sores.

Arteriovenous Fistula on Forehead after Autologous Fat Injection: A Case Report

PURPOSE: Autologous fat injection is ideal for patients who wish to add contour, projection and gross volumization of the aging, atrophic face and is claimed to be a safe procedure. However, there are several case reports in the literature where patients have suffered from acute visual loss and cerebral infarction after facial fat injection. This paper explores a rare case of vessel related complication, an arteriovenous fistula that occurs after fat injection on forehead. METHODS: A 28-year-old female who showed a non- tender, soft 1.0x2.5cm sized mass on forehead for 3 weeks. A thrill could be detected on the tortuous dilatated vessel-like structure around the mass. She had a fat injection on forehead for soft tissue augmentation 3 months prior to developing the mass. 3-dimensional brain CT angiography showed arteriovenous fistula. RESULTS: The fistula is totally excised with ligation of feeding vessels. Pathology report showed an atypical vessel which had intimal thickening, myxoid degeneration and thrombus formation. There were no evidences of recurrence at least for 2 months of follow-up. CONCLUSION: An occurrence of arteriovenous fistula after autologous fat injection is very rare. After perforation of artery and vein by coincidence, blood extravasates with the formation of a hematoma capsule and a pseudocapsule around it. The hematoma capsule would expand and clot would reabsorb resulting in a cavity leading to fistula formation. Other vessel related complications like acute visual loss or cerebral infarction are very severe. Therefore, surgeons should be cautious during facial fat injection to avoid vessel injuries.