Management of Auricular Hematoma in a Wrestler
The most appropriate management for this 18-year-old wrestler with a large 3-cm auricular hematoma is to incise and drain the hematoma and apply a pressure dressing.
Rationale for Incision and Drainage with Pressure Dressing
Auricular hematomas require prompt and effective management to prevent the development of "cauliflower ear," a permanent deformity that results from improper healing of the auricular cartilage. The evidence strongly supports incision and drainage followed by pressure dressing as the most effective approach for several reasons:
- Incision and drainage with pressure dressing has been shown to have the lowest recurrence rate compared to simple aspiration or no treatment 1
- This approach allows for complete evacuation of the hematoma and prevents reaccumulation of blood between the perichondrium and cartilage
- Early intervention prevents the formation of fibroneocartilage that can lead to permanent deformity 2
Treatment Algorithm
Preparation and Anesthesia
- Clean the ear with antiseptic solution
- Administer local anesthesia (1% lidocaine) to the affected area
Incision and Drainage Procedure
- Make a small incision along the natural fold of the ear
- Completely evacuate the hematoma
- Irrigate the cavity with sterile saline
Pressure Dressing Application
- Apply through-and-through absorbable mattress sutures to eliminate dead space 1
- Place pressure dressing over the entire auricle
- Ensure even pressure distribution to prevent recurrence
Follow-up Care
- Maintain pressure dressing for 5-7 days
- Prescribe prophylactic antibiotics to prevent infection
- Schedule follow-up within 24-48 hours to check for reaccumulation
Evidence Comparison of Treatment Options
| Treatment Method | Advantages | Disadvantages | Recurrence Rate |
|---|---|---|---|
| No treatment | None | Leads to permanent deformity | Not applicable |
| Simple aspiration | Quick, minimal invasion | High recurrence rate | 43% [1] |
| Pressure dressing alone | Non-invasive | Inadequate evacuation | Moderate |
| Incision and drainage with pressure | Low recurrence, preserves anatomy | Requires skill | 5% [1] |
Important Considerations
- Timing is critical: Early intervention (within days of injury) yields the best cosmetic outcomes
- Avoid simple aspiration: While less invasive, simple aspiration has a high recurrence rate and often requires repeated procedures 1
- Monitor for complications: Watch for signs of infection, pressure necrosis, or reaccumulation
- Athletic considerations: Using a properly designed pressure dressing can allow the athlete to return to training sooner 3
Potential Complications and Prevention
- Reaccumulation: Ensure complete evacuation and proper pressure dressing
- Infection: Use sterile technique and consider prophylactic antibiotics
- Pressure necrosis: Check pressure dressing within 24 hours
- Permanent deformity: Proper initial management is essential to prevent "cauliflower ear"
For this 18-year-old wrestler with a large 3-cm auricular hematoma, incision and drainage followed by pressure dressing represents the most effective approach to preserve normal auricular contour and prevent long-term deformity while allowing for the quickest return to athletic activities.