What is the treatment for a linear wound on the ear auricle?

Treatment of Linear Wound on Ear Auricle

All auricular lacerations should be cleaned and repaired within 12 to 24 hours under local anesthesia (without epinephrine), with simple linear tears sutured using either skin-to-skin sutures alone or combined with intercartilage sutures if cartilage is involved. 1

Immediate Wound Management

• Clean the wound thoroughly using sterile technique before any repair to prevent infection, particularly perichondritis which can lead to permanent cartilage deformity 1, 2
• Assess the depth of the laceration to determine if cartilage is involved, as this requires additional intercartilage sutures beyond simple skin closure 1, 2
• Ensure all wound edges are properly matched during repair to restore normal auricular contours and prevent cosmetic deformity 2

Suturing Technique

• For simple skin-only lacerations: Use skin-to-skin sutures under local anesthesia without epinephrine (epinephrine can compromise blood flow to the already vulnerable auricular tissue) 1
• For lacerations involving cartilage: Combine skin sutures with intercartilage sutures to provide structural support and prevent cartilage warping 1, 2
• Any exposed cartilage must be covered with vascularized tissue to prevent infection and necrosis 2

Post-Repair Infection Prevention

• Apply topical antibiotic ointment (such as bacitracin) to the sutured wound 1-3 times daily, which can be covered with a sterile bandage 3
• Monitor closely for signs of perichondritis in the first month after injury, particularly during warm weather months when infection risk is highest 1, 4
• Watch for painful swelling, warmth, and redness that spares the earlobe, which indicates perichondritis rather than simple skin infection 1, 4

When to Escalate Treatment

• If perichondritis develops: Start fluoroquinolone antibiotics (ciprofloxacin or levofloxacin) immediately as these cover Pseudomonas aeruginosa and Staphylococcus aureus, the most common pathogens 1, 4
• If abscess forms: Surgical incision and drainage are necessary, though good cosmetic preservation becomes difficult once this occurs 1, 4
• Acute tenderness when deflecting the auricular cartilage distinguishes deeper perichondrial infection from superficial skin infection and requires systemic antibiotics 1, 4

Critical Pitfalls to Avoid

• Never use epinephrine in local anesthesia for ear repairs, as it can compromise already tenuous blood supply 1
• Do not delay repair beyond 12-24 hours, as this increases infection risk and compromises healing 1
• Avoid treating suspected cartilage infections with antibiotics that don't cover Pseudomonas, as this leads to treatment failure and permanent deformity 4
• Do not underestimate minor-appearing wounds involving cartilage, as perichondritis can progress rapidly to abscess formation and necrosis 1, 2

Follow-Up Care

• Re-examine within 48-72 hours to ensure no signs of developing infection 1
• If the wound was from earring trauma and the hole has closed, the ear can be repierced in an unscarred area after approximately 3 months of complete healing 1