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structure that provides the framework for the complex shape of the ear. The
perichondrium covering the cartilage provides it with nutrients and oxygen.
Traumatic separation of the cartilage from the perichondrium may lead to
necrosis, leaving the auricle deformed. The overlying skin is thin but well
vascularized. Skin flaps with small pedicles often survive and should not be
hastily debrided. Simple auricular lacerations can be repaired without
consultation. To avoid chondritis, approximation of the skin is important so no
cartilage is exposed. It is imperative to avoid catching the auricular cartilage with
the needle tip because the skin and perichondrium are in close proximity to each
other. Occasionally, debridement of the cartilage is needed to obtain complete
coaptation of the wound; however, cartilage debridement should be kept to a
minimum and only performed by providers comfortable with this type of repair.
Complex auricular lacerations with significant skin damage and involvement of
the auricular cartilage can be difficult to repair and may require consultation with
a surgical specialist. In general, when repairing auricular cartilage, 5-0 absorbable
sutures should be used to approximate the edges. Landmarks of the auricle should
be used for proper alignment. The perichondrium should be included in the
sutures so the suture material does not tear through the friable cartilage and also
to ensure restoration of nutrient and oxygen supply. For the same reason,
excessive tension should be avoided. Closure of the skin should follow as
described previously. If the laceration involves the anterior and posterior aspects
of the ear, closure of the posterior aspect first is recommended.
To avoid a deep scar line (notching) in repairing the earlobe or the auricular
rim, the skin edges should be everted at the time of closure because fibrotic tissue
will eventually pull the scar line down, leading to notching.
For partial avulsion or total amputation of the ear, make every effort to reattach
the amputated part because tissue survival and cosmetic outcome are often
favorable. Furthermore, blunt ear trauma can lead to a simple contusion or a
significant subperichondrial hematoma that can comprise the auricular cartilage.
Classically, a significant perichondrial hematoma is tense and appears as smooth
ecchymotic swelling that disrupts the normal contour of the auricle. This injury is

particularly common among wrestlers. Auricular hematoma should be promptly
drained to avoid necrosis of the cartilage and deformed auricle or cauliflower ear
(see Chapter 106 ENT Trauma ).
After repair of ear lacerations or evacuation of an auricular hematoma, a
pressure dressing should be applied. Follow-up in 24 hours to evaluate vascular
integrity to the area is recommended.

Nasal Lacerations