From the Guidelines
Management of auricle laceration involving cartilage requires prompt attention to prevent complications like infection, deformity, or cauliflower ear, and should be treated with thorough cleaning, careful examination, and repair using 6-0 nylon sutures for skin and 5-0 or 6-0 absorbable sutures for cartilage, along with antibiotic prophylaxis. The initial management includes thorough cleaning of the wound with sterile saline or antiseptic solution like chlorhexidine 1. After cleaning, careful examination should be performed to assess cartilage involvement and alignment. For repair, use 6-0 nylon sutures for skin and 5-0 or 6-0 absorbable sutures like PDS or Vicryl for cartilage, ensuring precise anatomical alignment. Antibiotic prophylaxis is essential; prescribe oral antibiotics effective against skin flora such as cephalexin 500mg four times daily for 7-10 days or amoxicillin-clavulanate 875/125mg twice daily for 7-10 days, as the most common pathogens often respond well to fluoroquinolone antibiotic treatment, such as ciprofloxacin or levofloxacin 1. Apply a non-adherent dressing and consider a pressure dressing to prevent hematoma formation. Patients should be instructed to keep the area dry for 48 hours, then clean gently with mild soap and water. Follow-up within 5-7 days is recommended to assess healing and remove non-absorbable sutures. Cartilage lacks direct blood supply, making it susceptible to infection and delayed healing, which is why meticulous wound care and antibiotic coverage are crucial for optimal outcomes and preservation of auricular aesthetics. Some potential complications to be aware of include auricular perichondritis and perichondrial abscess, which can occur in the first month after piercing, especially during warm-weather months, and can present as painful swelling, warmth, and redness in a portion of the auricle 1. If an abscess is present, surgical incision and drainage often are necessary, and good cosmetic preservation of the auricular cartilage is difficult to maintain 1. In cases of trauma to the pierced external ear, lacerations to the ear may occur after falls, motor vehicle crashes, contact sports, person-to-person violence, or accidental pulling of an earring, and all wounds should be cleaned and repaired within 12 to 24 hours 1. A simple earlobe tear can be sutured under local anesthesia, and if the hole has closed, the earlobe can be repierced in an unscarred area after ∼3 months 1.
From the Research
Management of Auricular Lacerations Involving Cartilage
The management of auricular lacerations involving cartilage typically involves thorough wound closure and prevention of infection 2. The goals of laceration repair are to achieve hemostasis and optimal cosmetic results without increasing the risk of infection 3.
Treatment Protocols
- Smaller injuries of the auricle, such as lacerations without tissue loss, have more or less standardized treatment protocols that require thorough wound closure of each affected layer 4.
- Even extended lacerations of larger parts of the ear quite often heal with only minor irregularities 4.
- In cases of partial or complete amputations of the ear, direct wound closure is a straightforward and safe option, with subsequent thoughtfully planned secondary reconstruction using ear or rib cartilage, or even allogenous material as an ear framework, can achieve excellent aesthetic results 4.
Prevention of Infection
- All wounds of the auricle carry a risk of infection leading to perichondritis 2.
- Principles of successful treatment are conservation of tissue and prevention of infection 2.
- The use of nonsterile gloves during laceration repair does not increase the risk of wound infection compared with sterile gloves 3.
- Irrigation with potable tap water rather than sterile saline also does not increase the risk of wound infection 3.
- Tetanus prophylaxis should be provided if indicated 3.
Specific Considerations
- Local anesthetic with epinephrine in a concentration of 1:200,000 is safe for use on the ears 3.
- Wounds heal faster in a moist environment and therefore occlusive and semiocclusive dressings should be considered when available 3.
- Auricular lacerations involving the cartilage are usually managed by Plastics Surgeons 5.