From the Research
Posterior auricular lacerations with exposed and broken cartilage should be managed with meticulous cleaning, conservative debridement, and careful repair to prevent complications like infection, deformity, and chondritis, as suggested by the most recent study 1. The management of such lacerations involves several key steps:
- Thorough irrigation of the wound with normal saline to remove debris and contaminants.
- Application of local anesthesia using 1% lidocaine with epinephrine, avoiding epinephrine on the ear lobe.
- Conservative debridement of devitalized tissue, preserving as much viable cartilage as possible.
- For cartilage repair, using 5-0 or 6-0 absorbable sutures like PDS or Monocryl to approximate the broken cartilage edges, ensuring the perichondrium is included in the repair when possible.
- Closing the overlying skin using 6-0 nylon or polypropylene sutures with simple interrupted or vertical mattress techniques, avoiding placement of sutures through the cartilage itself.
- Application of antibiotic ointment and a non-adherent dressing, with prescription of prophylactic antibiotics that cover Pseudomonas and Staphylococcus, such as ciprofloxacin 500mg twice daily for 7-10 days, as noted in earlier studies 2, 3, 4, 5. The importance of careful repair is underscored by the fact that cartilage lacks direct blood supply and relies on the perichondrium for nutrition, making it susceptible to infection and poor healing if not properly managed 1.