Abstract
Purpose
This study aimed to describe a “bolsterless” technique for managing auricular hematomas in professional fighters.
Methods
Eight auricular hematomas were drained under local anesthesia by incising along an anatomical auricular crease. After evacuation of the hematoma and copious irrigation, the resultant skin flap was replaced in anatomical position, and through-and-through absorbable mattress sutures were used to secure the flap in place. Incision sites were left open and dressed with antimicrobial ointment. No bolsters were placed. The patients were given 1 week of oral antibiotic therapy.
Results
All 8 hematomas resolved without further intervention. All 8 ears returned to their preinjury cosmetic state. Fighters were able to return to training within a week of the initial injury. No postoperative infections or other complications were noted.
Conclusions
In contrast to wrestlers, mixed martial artists (also called “ultimate fighters”) do not routinely wear protective head gear. As a result, they are at increased risk of recurrent auricular hematomas, often resulting in severe auricular deformities (cauliflower ear). These patients are anxious to return to training and fighting, and are reluctant to wear a bolster after repair. At their urging, we agreed to attempt this bolsterless technique. Although 2 patients in this series already had a significant cauliflower ear before being treated for the current hematoma, in all cases the auricle returned to its preinjury condition. Bolsterless treatment using mattress sutures and cosmetically placed incisions represents a successful technique for management of auricular hematomas in this population.
1
Introduction
Auricular hematomas are a frequent complication of blunt force trauma to the external ear, often seen in contact sports such as wrestling, boxing, and martial arts. Traditional management of the auricular hematoma has involved incision and drainage followed by placement of a bulky bolster to keep pressure and eliminate the dead space to prevent reaccumulation of the hematoma . Untreated or recurrent hematomas can cause infection and neocartilage formation with fibrosis, resulting in a severe auricular deformity (cauliflower ear). Mixed martial artists (MMA), or “ultimate fighters,” are particularly prone to auricular hematomas because their fighters use no head gear or ear protection, unlike wrestlers and amateur boxers.
We began seeing MMA with auricular hematomas in 2006. Initially we treated them with standard incision and drainage followed by bolster placement. Contrary to our recommendations, one fighter returned to training while the bolster was still in place, resulting in immediate reaccumulation of the hematoma. Since that time, and at the urging of the MMA, we have used a “bolsterless” technique. Here, we describe our experience using this bolsterless technique in a series of MMA who did not wish to have their regular training schedule interrupted because of a bulky pressure dressing.
2
Materials and methods
2.1
Study design
A 2-year retrospective analysis of 8 cases of auricular hematomas in professional MMA was performed, evaluating treatment and outcomes.
2.2
Technique
A sterile prep was applied to the area of the affected ear. Local anesthetic (1% lidocaine) with epinephrine (1:100 000) was injected over the area of the hematoma in the triangular fossa, conchal bowl, or scaphoid fossa depending on the location(s) of the hematoma. A no. 15 blade was used to make a 1- to 2-cm incision that paralleled 1 or more of the cartilaginous creases of the helical rim, superior or inferior crus of the antihelix, antihelical tail, or antitragus, dictated by the location of the collection ( Fig. 1 B ). Blunt dissection with a hemostat was used until the hematoma was encountered and evacuated. The area was copiously irrigated with saline. A 5-0 chromic suture was passed from the anterior surface of the pinna to the posterior surface, and back in a mattress style. The minimum number of sutures required to keep the skin flaps firmly coapted to the cartilage was applied ( Figs. 1C and 2A ). The incision site was left open to facilitate additional drainage. Antibiotic ointment was liberally applied to the incision sites and no dressing was applied. Patients were given a 1-week course of oral antibiotics.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
