Resident Manual of Trauma to the Face, Head and Neck

cartilage, and to prevent back-fracture of the cartilage as the surgeon sews toward himself or herself. 3. Approximation of the Helix and Antihelix Meticulous approximation of the helix and antihelix is necessary to maintain structural and cosmetic integrity of the underlying framework. Lacerations involving the free edges of the pinna (i.e., helix, lobule) require accentuated skin eversion with mattress sutures. This will help prevent notching that may occur from scar contracture and depression during the healing process (Figure 9.3). 5. Hematomas and Seromas Hematomas and seromas require evacuation. 6. Perichondrial Coaptation to the Cartilage Framework Plain gut sutures, chromic quilting sutures, or bolster dressings aid in perichondrial coaptation to the cartilage framework and eliminate dead space. This is crucial to maintain cartilage viability and prevent cauli- This will help prevent an acquired auricular deformity. 4. Lacerations Involving the Free Edges of the Pinna

flower ear or pseudocyst deformities. 7. Segmental Avulsion of the Pinna

For segmental avulsion of the pinna, the cartilage skeleton should be deepithelialized and thoroughly cleansed to minimize bacterial load.

Figure 9.3 Right ear laceration closed primarily. Vertical mattress sutures used to provide accentuated skin eversion. With scar maturation and retraction, incision line flattens without significant notching of the rim.

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