Procedure: Auricular Drainage & Dressing

• See Video: Auricular Hematoma - Brown EM Residency

Procedure: Needle Aspiration

• 1) Sterile preparation
• 2) Local or regional anesthesia with 1% or 2% lidocaine without epinephrine
  • Option for local in the area of incision or to do a regional auricular field block
• 3) 18G or 20G needle placed at point of maximal hematoma fluctuance
• 4) Aspirate blood, and “milk” ear to express additional blood

Procedure: Incision & Drainage (I&D)

• 1) Sterile preparation
• 2) Local or regional anesthesia with 1% or 2% lidocaine without epinephrine
  • Option for local in the area of incision or to do a regional auricular field block
• 3) Make a semicircular incision through the skin, with caution not to violate the underlying perichondrium
  • Try to use the minimal necessary incision size (should be no greater than 1 cm)
  • Position in area of least cosmetic deformity by incising at inner curvature of the helix or antihelix, e.g. at the superior aspect of the helix
• 4) Evacuate blood with manual compression
  • Further clotted blood can be broken up and removed with curved hemostats
  • +/- irrigation +/- suction PRN
• 5) Apply compressive dressing +/- bolsters

Procedure: Pressure dressing (post drainage)

• Should be placed following evacuation to prevent reaccumulation over several days
• Several options exist but all include pressure on both posterior and anterior aspect to maintain pressure

Option 1: Compressive wrap

• Could apply thick pressure dressing with petroleum jelly gauze posteriorly and anteriorly then use compressive wrap
• See photo below for procedure
• Variations exist, in which also could put suture through both sides of compression wrap to hold compression wrap more firmly in place

Option 2: Auricular bolster

• Compress auricle between two bolsters (cylinder dental roll) and suture through the cartilage
  • 1) Sandwich auricle between two bolsters
  • 2) Suture through the first bolster, auricle, and second bolster and tie
  • 3) Repeat suture at a second location along the bolster
  • 4) Apply additional compressive dressing over top of the ear and wrap around the head (see above)