Pt. with a laceration through the helix of the ear with exposed cartilage
2 Point Ear Block:
Am Fam Physician. 2004 Feb 1;69(3):585-590.
Goal: Approximate cartilage with absorbable 5-0 monocryl. It’s ok to trim away small amount of jagged or devitalized skin or cartilage to ensure proper approximation. Close the skin over the cartilage with 5 or 6-0 non-absorbable. Approximate landmarks first. Extensive tissue devitalization or damage, you should involve face.
Dressing: Place a compressive dressing with petroleum gauze to fill the antihelix of the ear then place 4 folded 4×4’s posteriorly behind the helix and wrap the head in an ace wrap. Place the patient on antibiotics and followup within 5 days.
Thanks for the post, Sean. Couple other pearls for ear lacs, which are definitely within our scope of practice.
– Yes, trimming the exposed cartilage is ok if needed, but be VERY judicious as even a small amount of trimming can cause a big cosmetic change.
– Preventing an auricular hematoma after repair is essential. Another way to do this besides what Dr Lowe has described is to place dental rolls on either side of the ear and suture all the way through each (picture here: https://www.ebmedicine.net/spaw/uploads/aboutUs/Figure%206.%20Technique%20For%20Bolster%20Of%20A%20Drained%20Auricular%20Hematoma.png).
– Antibiotic prophylaxis is, like with hand lacerations and nasal packing, without evidence, but almost universally recommended.