Provider Prepared’s Weekly Pearl of Wound Wisdom #27 Soccer cleat to the ear!

A 20-year-old male presents to the emergency department with extensive wound to his left ear which occurred while playing an aggressive soccer game.  Another player's soccer cleat became caught in the patient's ear gauge creating extensive auricular injury.

Complex auricular lacerations are those that expose the cartilage or extend through the cartilage. These wounds require very careful and detailed closure. In general, sutures should not be passed through the cartilage itself. In order prevent notching or a step-deformity, the perichondrium must be reapproximated. The cartilage must also be covered with skin for appropriate cosmetic repair.

The skin of the ear is so thin and firmly adhered to the perichondrium, stitches that simultaneously reapproximate both layers are acceptable. The perichondrial layer should be the deepest layer of sutured tissue.If absorbable suture is used, it should not be dyed material to avoid tattooing of the repaired tissue.
Malloy, KE et al. Assessment and management of auricle lacerations. UpToDate, November 2016

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Provider Prepared

Nathan Whittaker, MD