Current concepts in surgical management of traumatic auricular hematoma

Incision and Drainage Followed by Mattress Suture Repair of Auricular Hematoma

“…In addition to extracting the hematoma, the nidus for fibroneocartilage formation, management requires effective dead‐space elimination to prevent reaccumulation. Many methods have been reported 1–9 . Needle aspiration alone—as shown by this series with three of four ears demonstrating reaccumulation, as well as by evidence from the literature 5,7,9 —is not a sufficient treatment; it does not eliminate the potential space.…”

“…Auricular hematoma treatment and cauliflower ear prevention are based on understanding of the underlying pathophysiology. An untreated hematoma undergoes fibrosis and forms new, abnormal cartilage or neocartilage 9–11 . Disagreement and debate exists regarding the location of hematoma formation.…”

“…Pandya's animal model described intracartilaginous formation based on observations made after dropping weights with increasing frequency on rabbit ears over 20 weeks resulting in significant damage with through‐and‐through cartilage tearing 10 . This thought of intracartilaginous formation held by some 2,10,12 contrasts with other descriptions of subperichondrially located hematomas which undergo fibroneocartilage formation through perichondrial mesenchymal cell stimulation leading to cauliflower ear development 9,11,13 . Ohlsen's animal model determined that subperichondrially‐placed blood in the ears of rabbis resulted in cauliflower ear formation as opposed to subcutaneously‐placed blood, which resolved by 2 weeks 11 .…”

“…Other methods described include needle drainage with casting, 2 molding, 3 or absorbable mattress sutures 4 . Incision and drainage techniques with drain placement, 5 perichondrium and fibroneocartilage excision followed by cotton bolstering, 1 button compression with through‐and‐through sutures, 6 cotton dental roll bolstering with mattress sutures, 7 and thermoplastic splinting 8 and other means of stenting 9 have also been described.…”

The Surgical Treatment of Traumatic Hematoma of the Auricle

“…Understanding the pathophysiology of the auricular hematoma and its possible sequela, the cauliflower ear, will direct the appropriate intervention for the injury. The goals of treatment, as described by Starck and Kaltman, 3 are to drain the hematoma, to prevent recurrence of the fluid, and to remove any fibroneocartilage that has developed.…”