Auricle laceration repair
The case
Last night, a nice young man presented with an injury to his right ear after a mechanical fall onto some jagged rocks. Unfortunately, I didn't get a photo of the initial injury, but he had a horizontally-oriented laceration extending from the helix to the concha, through the cartilage but not through-and-through the posterior aspect of the ear.
The wound was thoroughly cleaned and there were no retained foreign bodies. There was no auricular hematoma or tissue avulsion. The remainder of his history and physical exam were normal.
The brush up
Recall the sensory innervation of the auricle. The majority comes from 3 nerve branches: the great auricular nerve (C2, C3), the lesser occipital nerve (C2), and the auriculotemporal nerve (V3). There is also a small amount of sensory innervation from branches of the vagus and facial nerves (within the concha), but for simplicity we will think of the regional innervation in this way:
For this patient, I decided to do an auricular block - a GREAT way to anesthetize part or all of the ear to avoid distorting landmarks/anatomy while providing excellent anesthesia.
For this regional block, it is safe to use 1% lidocaine with epinephrine. I typically draw up 10 mL of anesthetic and divide it equally among the 4 areas. Note that you really only have to poke the patient twice for this block; just redirect the needle after anesthetizing areas #1 and #3:
The conclusion
The cartilage/perichondrium was repaired with 4-0 Vicryl, and the skin layer was closed with 5-0 fast-absorbing plain gut (all simple interrupted fashion). You could (and it may be preferable to) use non-absorbable sutures like Prolene or nylon. I oped for absorbable sutures due to lack of appropriate follow-up (as he was visiting from another country).
We placed an ear compression dressing (important for preventing auricular hematoma development), and I asked the patient to return in 2-3 days for a wound check. We were both happy with the outcome! :)
References:
1. Malloy KM and Hollander JE. Assessment and management of auricle (ear) lacerations. In: UpToDate, Wiley, II JF (Ed), UpToDate, Waltham, MA, 2014.