Management of Auricular Hematoma With Bolster Versus Quilting: A Retrospective Cohort Study

Auricular hematomas commonly result from soft tissue trauma and require prompt drainage and pressure dressing to prevent recurrence and deformity. Both bolster and quilting suture techniques are used post-drainage, but direct comparisons are lacking. The objective of this study is to compare outcomes between bolster dressings and through-and-through mattress quilting sutures in the management of auricular hematomas.

A 15-year retrospective chart review was conducted for patients age > 10 years presenting to the Emergency Department with auricular hematoma. Exclusion criteria included developmental delay, anticoagulant use, infectious etiology, or subsequent diagnosis of relapsing polychondritis. Cases were analyzed for complications and recurrence.

Forty-three patients met inclusion criteria (95% male; mean age 33 years). Thirty (73%) were managed with bolsters and 13 (27%) with quilting sutures. Recurrent hematoma occurred in 30% (9/30) of the bolster group and 0% (0/13) of the quilting group, including 11 primary cases and 2 salvage cases (p = 0.036). No significant differences were observed between the two groups in terms of complications (p = 1.0) or scarring (p = 0.29).

Quilting suture technique had lower rates of recurrence compared to bolster dressings for auricular hematoma management. These findings support quilting as an acceptable option following hematoma drainage, with controlled studies necessary to determine comparative efficacy.