• D Köhler and T Pohlemann.
• Klinik für Unfall-, Hand und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstr. 1, 66421, Homburg/Saar, Deutschland. daniel.koehler@uks.eu
• Oper Orthop Traumatol. 2011 Feb 1; 23 (1): 15-20.

ObjectiveEvacuation of hematoma, hemostasis, reduction of dead space by vacuum systems for minimization of secondary complications, such as full skin necrosis, deep infections, and secondary wound closure.IndicationsMorel-Lavallée lesion (MLL), all larger epifascial hematomas.ContraindicationsNone.Surgical TechniqueCentral longitudinal incision, detection of the extent of the hematoma, transection of the full length of the lesion, hemostasis, debridement, application of vacuum systems, secondary wound closure, or splitskin coverage.Postoperative ManagementVacuum therapy must be continued until secretions are less than 30 ml/24 hours. Negative bacterial culture before wound closure is imperative. Daily change of wound dressings, frequent control of inflammation parameters. Weight bearing until consolidation of soft tissue.ResultsOperative treatment of the MLL with vacuum systems is a relatively new concept, and results on larger collectives have not been published yet. A total of 8 patients in our hospital underwent vacuum therapy after sustaining a MLL, 5 of them with concomitant instability of the pelvic ring. Emergency stabilization and initiation of vacuum therapy were performed on the day of admission. Three patients had initially positive bacterial colonialization. Duration of vacuum therapy was 8.5 days (range 4-14 days). Dressings were changed every 2.6 days (range 1-4 days). While 6 wounds could be closed secondarily, 2 needed split skin coverage. Complications were not observed. Vacuum therapy facilitates wound management and helps reduce bacterial colonialization. It has also been proved to have a beneficial effect on qualitative and quantitative granulation.

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