Minimally Invasive Dual Negative-Pressure Strategy for Extensive Morel–Lavallée Lesions

Morel–Lavallée lesions (MLLs) of the lower extremities frequently progress to large, encapsulated fluid collections, where persistent dead space becomes the principal driver of recurrence and wound-related complications. Although extensive open debridement can achieve durable cavity obliteration, it may compromise residual perforators and increase soft-tissue morbidity. We describe a minimally invasive technical strategy that combines internal closed-suction drainage with external negative-pressure wound therapy (NPWT) over the dead-space footprint. Following limited incisional evacuation, strategically positioned internal drains provide continuous intracavitary fluid removal, while external NPWT delivers uniform pressure-mediated tissue apposition to facilitate sustained cavity collapse. This coordinated pressure configuration enables effective dead-space control without routine pseudocapsule excision or wide soft-tissue dissection. In two illustrative cases, stable wound healing was achieved without recurrence during the available follow-up period. This dual negative-pressure approach may offer a reproducible and minimally invasive option for managing extensive or encapsulated MLLs by integrating internal evacuation with external compression to promote durable dead-space obliteration, while also potentially reducing procedure-related morbidity.