structure that provides the framework for the complex shape of the ear The perichondrium covering the cartilage provides it with nutrients and oxygen Traumatic separation of the cartilage from the perichondrium may lead to necrosis, leaving the auricle deformed The overlying skin is thin but well vascularized Skin flaps with small pedicles often survive and should not be hastily debrided Simple auricular lacerations can be repaired without consultation To avoid chondritis, approximation of the skin is important so no cartilage is exposed It is imperative to avoid catching the auricular cartilage with the needle tip because the skin and perichondrium are in close proximity to each other Occasionally, debridement of the cartilage is needed to obtain complete coaptation of the wound; however, cartilage debridement should be kept to a minimum and only performed by providers comfortable with this type of repair Complex auricular lacerations with significant skin damage and involvement of the auricular cartilage can be difficult to repair and may require consultation with a surgical specialist In general, when repairing auricular cartilage, 5-0 absorbable sutures should be used to approximate the edges Landmarks of the auricle should be used for proper alignment The perichondrium should be included in the sutures so the suture material does not tear through the friable cartilage and also to ensure restoration of nutrient and oxygen supply For the same reason, excessive tension should be avoided Closure of the skin should follow as described previously If the laceration involves the anterior and posterior aspects of the ear, closure of the posterior aspect first is recommended To avoid a deep scar line (notching) in repairing the earlobe or the auricular rim, the skin edges should be everted at the time of closure because fibrotic tissue will eventually pull the scar line down, leading to notching For partial avulsion or total amputation of the ear, make every effort to reattach the amputated part because tissue survival and cosmetic outcome are often favorable Furthermore, blunt ear trauma can lead to a simple contusion or a significant subperichondrial hematoma that can comprise the auricular cartilage Classically, a significant perichondrial hematoma is tense and appears as smooth ecchymotic swelling that disrupts the normal contour of the auricle This injury is particularly common among wrestlers Auricular hematoma should be promptly drained to avoid necrosis of the cartilage and deformed auricle or cauliflower ear (see Chapter 106 ENT Trauma ) After repair of ear lacerations or evacuation of an auricular hematoma, a pressure dressing should be applied Follow-up in 24 hours to evaluate vascular integrity to the area is recommended Nasal Lacerations