A 62-year-old female was seen for right-sided chronic seroma/hematoma present for three to four years, previously treated with needle decompression, incision, and drainage with curettage, long-term bolsters, and oral antibiotics. At presentation, she was “pressing out fluid” three to four times a day through a sinus tract through a prior incision and drainage. Again, the same technique was used, in which several 3-mm “hole punches” were created through the diseased cartilage, taking care to place the punches in non-structural areas of the ear, such as the triangular fossa and scaphoid fossa, to preserve the superior anti-helical fold. Again, closure involved apposition of the perichondral envelopes of the anterior skin and posterior skin without intervening cartilage, and a bolster was applied (see supporting video). The bolster was removed after two to three weeks, and the site continued to heal on postoperative days 12 and 25. She had no recurrence and a mild helical rim deformity at her one-year postoperative visit. The helical rim deformity was likely due to the chronicity of the disease process at the time of treatment, involving more extensive cartilage and scar tissue removal to optimally expose the anterior skin perichondral envelope to the posterior skin perichondral envelope.
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November 2022RESULTS
This hole-punch technique was performed on five recalcitrant (at least two prior drainages with subsequent re-accumulation) post-traumatic recurrent auricular hematomas. Each had open drainage, hole-punching of the cartilage, and xeroform bolster placed for five to 21 days. All patients had excellent results with no additional recurrences, and no patients developed cauliflower deformity.