From the Research
Management of auricular (ear) lacerations in the Emergency Department (ED) requires careful assessment and prompt treatment to preserve both function and cosmetic appearance, with the most recent evidence suggesting that wound irrigation with tap water is a safe and effective alternative to sterile normal saline, as shown in a prospective, double-blind, randomized, controlled clinical trial 1.
Initial Management
Initial management involves controlling bleeding with direct pressure, followed by thorough cleaning of the wound with tap water or normal saline, as equivalent rates of wound infection were found using either irrigant 1. Local anesthesia using 1% lidocaine with epinephrine (1:100,000) is typically administered, avoiding epinephrine in the ear lobule to prevent tissue necrosis.
Closure Techniques
For simple lacerations, primary closure with 6-0 non-absorbable sutures (like nylon or polypropylene) is recommended, ensuring proper alignment of anatomical landmarks. Complex lacerations involving cartilage require layered closure, with 5-0 or 6-0 absorbable sutures for the cartilage and non-absorbable sutures for the skin. Topical skin adhesives may be used for simple, low-tension wounds, and have been shown to be associated with a shorter ED length of stay compared to sutures or staples 2.
Prophylactic Antibiotics and Post-Repair Care
Prophylactic antibiotics are indicated for cartilage involvement, typically amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days or clindamycin 300 mg four times daily for penicillin-allergic patients. Tetanus prophylaxis should be administered if needed. Post-repair care includes antibiotic ointment application, protective dressing, and suture removal in 5-7 days. Patients should be advised to keep the ear dry, avoid pressure on the affected ear, and return if signs of infection develop.
Key Considerations
Proper management is crucial as the ear's limited blood supply increases infection risk, and cartilage damage can lead to permanent deformity if not appropriately treated. The use of pressurized saline canisters for wound irrigation may facilitate ease of irrigation and decrease the time involved in this traditionally labor-intensive activity 3. Advanced laceration management techniques, including consultation with specialists, may be necessary for complex lacerations 4.