Chronic Recurrent Gluteal Morel-Lavallée Lesion Managed by En Bloc Surgical Excision: A Reconstructive Soft-Tissue Case Report

Abstract: Introduction: Morel-Lavallée lesions (MLLs) are closed degloving injuries resulting from shearing forces that separate the subcutaneous tissue from the underlying fascia. While acute forms may resolve with conservative management, chronic lesions often recur due to fibrous encapsulation, requiring definitive surgical intervention. Case Presentation: We report the case of a 36-year-old male police officer who sustained a pelvic trauma during a high-velocity accident in 2022. He developed a recurrent, encapsulated gluteal MLL that was incompletely treated by two prior procedures. The lesion persisted and progressively expanded, forming a voluminous soft-tissue mass in the left gluteal region. Imaging showed a hypoechoic, avascular collection measuring 12 × 10 cm. MRI confirmed fibroadipose infiltration and tissue hypertrophy without visible tumoral component. Surgical management consisted of an en bloc excision of the fibrous and adipose mass, followed by layered closure with Redon drainage. Results: The postoperative course was favorable. Serial ultrasound assessments over 4 months showed resolution of the collection with only inflammatory changes. Histopathology confirmed diffuse adipose hyperplasia without atypia or malignancy. Immunohistochemistry for MDM2 and Ki67 was negative. Conclusion: Chronic gluteal MLLs, particularly in active patients, pose diagnostic and therapeutic challenges. This case underscores the importance of early MRI diagnosis, recognition of encapsulated evolution, and radical surgical resection in recurrent forms. A reconstructive surgical approach with tension-free closure and appropriate drainage significantly improves outcomes and prevents further recurrence.