Introduction
- Surgical methods of treating an aural hematoma
:
- Prolonged drainage using an indwelling drain and pressure bandaging.
- Surgical incision and obliteration of the hematoma cavity.
Uses
Advantages
Indwelling drain
- Improved success rate, compared to simple needle drainage.
- Possible to perform in conscious dogs, under local anesthesia.
- Best success rate.
- Surgical scarring means less risk of recurrence.
Disadvantages
Indwelling drain- Increased cost if sedation and repeat bandaging required.
- Indwelling drain must remain in position for up to 3-4 weeks.
- General anesthesia required therefore increasing costs, and potential risk, to patient.
- Cosmetic result may be poor owing to deformity from scar formation.
- Head bandaging required for 5-10 days and an Elizabethan collar thereafter.
Preparation
Indwelling drain- 5 min (additional 15 mins if local anesthesia employed - in the waiting room).
- 10 min (additional time for premedication to take effect if administered).
Requirements
Materials required
Minimum equipment
- Standard surgical kit.
Minimum consumables
- Indwelling drain : small drain, eg teat drain or Penrose drain .
- Non-absorbable suture material - 2-0 monofilament.
- Saline flush.
- Sterile dressing and bandaging materials for head bandage.
Ideal consumables
- Obliteration : 'bolsters' for sutures, eg buttons, plastic disks, short sections of drip tubing.
Sequelae
Complications
- Indwelling drain : recurrence - hematoma too large/chronic.
- Obliteration : ear deformity due to scar formation - use of bicurved incision for large hematomas minimizes this risk.
Prognosis
- Good when correct choice of treatment for size/duration of hematoma.
- Best long term response when primary cause treated successfully.
- Cosmetic results vary according to size of hematoma and degree of scarring.
Reasons for treatment failure
- Unsuccessful procedure - wrong choice of technique.
- Recurrence - failure to treat initial cause of hematoma (ie self trauma due to otitis externa, aural foreign body, aural ectoparasitism - Otodectes cynotis
or Demodex canis
; pinnal ectoparatisism - Sarcoptes scabiei
, Neotrombicula autumnalis
or Spilosyllus cuniculi
.
Sources
Publications
- Recent references from PubMed.
- Joyce J A (1994) Treatment of canine aural haematoma using indwelling drain and corticosteroids. JSAP 35 (7) 341-344.
- Romatowski J (1994) Non-surgical treatment of aural hematomas. JAVMA 204 (9), 1318.
- Kuwahara J (1986) Canine and feline aural hematoma - clinical, experimental, and clinicopathologic observations. Am J Vet Res 47 (10), 2300-2308.
- Weber H O (1979) A technique for surgical treatment of aural hematoma in dogs and cats. Vet Med Small Anim Clin 74 (99), 1271.
