A rugby player presents 5 days after trauma with a large fluctuant anterior auricular haematoma. Aspiration performed elsewhere twice has recurred. What is the best management?
The key operative judgement is durable drainage plus compression; recurrence after aspiration signals inadequate dead-space control.
A. Incision and drainage with evacuation, bolster compression and follow-up for infection/reaccumulation: Organised or recurrent collections need complete evacuation and obliteration of dead space to protect cartilage from necrosis and cauliflower deformity.
B. Repeat aspiration and apply a light non-moulded dressing: At five days with two recurrences, incomplete evacuation and inadequate dead-space compression make further recurrence likely.
C. Place quilting sutures without first evacuating the organised clot: Compression cannot reappose perichondrium while clot remains.
D. Incise and drain but omit bolster or quilting compression: Drainage alone leaves the potential space open and predisposes to reaccumulation.
E. Allow fibrosis, then offer elective otoplasty: Waiting accepts preventable cartilage necrosis and a more complex secondary deformity.
If the injury were a tiny, fresh collection presenting within hours, aspiration with secure bolster and close review might suffice.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, or a substitute for local policy and specialist clinical judgement.
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