Use of silastic sheets with mattress-fashion sutures for the treatment of auricular hematoma.

INTRODUCTION An auricular hematoma is a commonly encountered clinical condition. A number of treatment options for auricular hematomas have been suggested, but a continuing controversy exists regarding the most effective therapy. Auricular hematomas are a consequence of the relatively unique histological features of auricle damage and the unusual pathophysiology of the lesion. In experimental studies involving rabbits, Ohlsen et al. suggested that the subperichondrium is the primary site of hematomas. Consequently, complete evacuation of blood from the subperichondrial space and closure of any space between the perichondrium and the auricular cartilage are most important when treating auricular hematomas. Further, simple aspiration of the hematoma is typically an insufficient treatment method. Recent studies have suggested intralesional injection of chemical compounds such as OK-432 to stimulate local inflammation and induce adhesion of the dead space, or of steroids to induce vasoconstriction and reduce extravasation of blood. Aspiration and injection methods might be useful for the treatment of small lesions. However, long-standing or large lesions require surgical management. Traditionally, the most widely used treatment has been incision and drainage, followed by the placement of cotton bolsters to eliminate the resulting empty space. Various materials have been used, including plaster mold, cotton wool bolster, and dental silicone material. However, simple compression methods are limited in terms of their ability to eliminate the empty space, as well as maintain the compressive material for a sufficient period. The use of mattress sutures could address some of these problems. Following the successful use of coaptation of mucoperichondrial flaps after septoplasty, the authors applied continuous running sutures through the posterior skin, cartilage, and the anterior skin in a mattress-like fashion to firmly fix the perichondrium to the cartilage. However, although this method allows better elimination of empty spaces, it can result in problems with even-pressure distribution. Furthermore, the pressure supplied by the sutures tends to be concentrated at small stitch points, which can result in ineffective compression of the areas between the stitches. Additionally, necrosis can develop at the stitch point as a result of the pressure. To address these problems, we have examined the use of mattress sutures using a Silastic sheet at the interface. This technique takes advantage of any previous mattress sutures and allows even distribution of pressure across the hematoma.