Incision, Repair of Ear Hematoma Recommended

Patients presented for treatment from 2 to 60 days after the original injury occurred. Two of the patients presented at 60 days, including one person who already had manifestations of cauliflower ear. The doctors treated a total of 28 hematomas in the 24 patients.

Mr. Iverson said that 19 hematomas were treated with the incision and drainage and use of mattress suture technique—by far the most favored techniques at his institution. One revision of the operation was required. He said that seven patients were treated with needle aspiration, but three of those patients required a repeat procedure. Two people were treated with the wick placement procedure. One of those patients required a revision.

The incision and drainage procedure is performed by injecting the affected part of the ear with local anesthetic, then making an incision along a natural crease to decrease the risk of visible scarring, he said in describing the procedure before the audience of more than 500.

Following the incision, the surgeon completely evacuates the hematoma. Mattress sutures are then woven through and through, providing for the skin of the ear to lie flat and resume the normal contour of the ear. The patients were followed up at one week and then at one month, at which time the sutures had absorbed and the ear remained in its normal shape, Mr. Iverson demonstrated in his oral presentation.

Mr. Iverson said that one of the patients was lost to follow-up and one person lost part of the contour of the ear; one patient did show cauliflower ear deformity, but that was one of the patients who presented at 60 days post-injury.

Among the needle aspiration patients, two patients developed significant cosmetic changes and two patients were lost to follow-up after the second procedure. One patient who had the wick placement developed chondritis.

Mr. Iverson performed his study under the mentorship of William Giles, MD, Clinical Assistant Professor of Pediatrics at the University of South Carolina School of Medicine in Columbia.

In response to questions from the audience, Dr. Giles said that treatment with incision and drainage can be accomplished even during the wrestling season. “We perform the procedure, teach the kids how to pack the ear, and instruct them to make sure they use protective headgear when they practice or wrestle. We have had no problems with that.

“We understand that wrestling is a big deal to these kids and that they are going to keep wrestling during the season,” Dr. Giles said.