What is the wound care order for a laceration of the right ear from scratching?

Wound Care for Right Ear Laceration from Scratching

For a laceration of the right ear from scratching, thorough cleaning with sterile normal saline or potable water followed by primary closure within 12-24 hours is recommended. 1

Initial Assessment and Cleaning

• Thoroughly irrigate the wound with a large volume of warm or room temperature potable water (tap water) or sterile normal saline until all foreign matter and debris are removed 1
• Cold water is equally effective but less comfortable for the patient 1
• No need for iodine or antibiotic-containing solutions for initial cleaning 1
• Remove only superficial debris; deeper debridement is usually unnecessary and may impair skin closure 1

Wound Closure Approach

• All ear lacerations should be cleaned and repaired within 12-24 hours of injury for optimal outcomes 1
• Simple ear lacerations can be sutured under local anesthesia 1
• For local anesthesia, use lidocaine with epinephrine in a concentration of 1:200,000 which is safe for use on ears 2
• Suture the wound using either:
  • Skin-to-skin sutures only, or
  • Combined approach with skin sutures and intercartilage sutures if cartilage is involved 3
• If the laceration occurred >12 hours ago but appears clean, closure may still be appropriate as recent evidence suggests the traditional "golden period" is less important than previously thought 4

Special Considerations for Ear Wounds

• Ensure all cartilage is covered with vascularized tissue to prevent chondritis 3
• Pay special attention to matching anatomical landmarks to preserve the normal contours of the ear 3
• If the laceration involves the auricular cartilage, be vigilant for signs of perichondritis (painful swelling, warmth, redness that spares the earlobe) 1
• Acute tenderness on deflecting the auricular cartilage helps distinguish perichondrial infection from superficial skin infection 1

Post-Closure Wound Care

• Cover the wound with a clean occlusive dressing to keep the wound moist and prevent drying 1
• Consider applying antibiotic ointment or cream if it's a superficial injury and the patient has no known allergies to antibiotics 1
• Instruct the patient to keep the wound clean and dry 1
• Advise elevation of the injured ear during the first few days after injury to accelerate healing, especially if swelling is present 1

Monitoring and Follow-Up

• Follow up within 24 hours either by phone or during an office visit 1
• Monitor for signs of infection: increasing pain, redness, swelling, warmth, or purulent discharge 1
• If infection develops, particularly auricular perichondritis, prompt treatment with fluoroquinolone antibiotics (e.g., ciprofloxacin or levofloxacin) is indicated as they cover common pathogens (Pseudomonas aeruginosa, S. aureus, and S. pyogenes) 1
• If an abscess develops, surgical incision and drainage may be necessary 1

Tetanus Prophylaxis

• Ensure tetanus prophylaxis status is current 1
• If outdated or unknown, administer tetanus toxoid (0.5 mL intramuscularly) 1

Potential Complications to Watch For

• Infection (particularly auricular perichondritis)
• Abscess formation
• Chondritis (most feared complication of ear injuries)
• Cosmetic deformity
• Keloid formation 1