The Ugly Pinna Hematoma 

D. E. Larsen, DVM

Sandy came back and leaned through the surgery room doorway.

“Kevin is on his way to the clinic,” Sandy said. “I tried to slow him down, but he was pretty excited. Finn, his cow dog, has a hematoma on his ear. I told him you were still in surgery, but he said he would come and wait.”

“He thinks a lot of Finn,” I said. “I am almost done here, so he won’t have to wait long.”

I quickened my pace, and I was putting the last skin sutures in this cat spay when I heard Kevin come through the front door.

“Go ahead and get Kevin into an exam room and get Finn’s vitals,” I told Dixie. “I will finish here, and I should be there before you’re done.”

When I got to the exam room, Dixie and just finished with Finn. Finn was standing on the table, wagging the almost stub of a tail. He didn’t have a care in the world. 

I expected to see a grossly swollen ear flap, but I could only see a slight bend on the right ear tip.

“What’s going on with Finn today?” I asked Kevin as I pulled off my surgery gloves and extended a hand.

“He has a hematoma on that right ear tip,” Kevin said, pointing to the bent ear tip. “I had a dog years ago with one that started like this, and I let it go a couple of days, and the whole damn ear filled up with blood. It was a hell of a mess healing up, and that ear flap was wrinkled and ugly for the rest of his life.”

“Yes, these things can be a mess sometimes,” I said. “Especially if they are a few days old.”

“When they repaired the one on that old dog, they made a big slice down the middle of the ear flap and then sutured the whole thing like a quilt,” Kevin said. “It seemed like it took forever to heal.”

“This is one of those repairs that if you go to the book, there are a couple of ways to do it, and that slice is one of them,” I said. “That is how I was taught in school. But when you start reading the literature, there are many ways to do the job. When you see that happen, it is because everyone is looking for a better way. I have changed the way I repair those large hematomas. I still suture them like a quilt, but instead of one big slice, I take a number of punches out of the skin with a biopsy punch. That seems to heal a lot better than the old slice.”

“What do you think about this little one?” Kevin asked.

“These things are snap,” I said. “I don’t suture these at all. Depending on what caused the hematoma, I don’t even use general anesthesia if the ear canal is not infected. I usually just clip the tip of the ear, inject a little lidocaine for local anesthesia and take one punch with a four-millimeter biopsy punch right at the tip of the ear. Then I place a Dr. Larson’s Teat Tube into that hole made by the biopsy punch. This teat tube is self-retaining, but I usually place a single suture to secure it in place. Then I wrap the ear and the head, so the flap is held down.”

“And then I would suppose you will use one of those cone things,” Kevin said.

“I rarely use those things,” I said. “They just make you and Finn miserable. I maybe use a half dozen a year. A few things need them, but most of the time, they are more trouble than they are worth.”

“I suppose you get a cut out of using the teat tube,” Kevin said.

“I wish,” I said. “I different Dr. Larson. It has been on the market for a long time. They are useful in cows for many things, but they also work great in this situation.”

“When can you do this?” Kevin asked.

“Let’s go back to the treatment area right now,” I said. “This isn’t going to take very long, and Finn will go home with you.”

I looked into Finn’s ear with an otoscope to make sure there was no problem there. Finding a normal ear canal, I wondered what caused this hematoma.

“What do you think happened to this ear?” I asked.

“We worked a bunch of heifers yesterday,” Kevin said. “You know these dogs, they work the cows hard when they are in the corral. I would guess that he got kicked or something.”

Back on the treatment table, we clipped Finn’s ear flap and prepped it with Betadine surgical scrub. I injected the skin where I planned to take the punch of skin with some lidocaine and then injected the remainder of the lidocaine in the syringe into the hematoma.

After waiting a brief time, I took a four-millimeter biopsy punch and made a neat hole at the tip of the pinna. Fresh blood spurted from the hole, and I squeezed the hematoma and expressed some clot material from the hole. 

Then I inserted the teat tube, so the retaining prongs were inside the hematoma and removed the screw top from the tube.

“I have done these without any sutures, but I find they stay a little better if I just take one suture around the neck of this tube and tie it to the skin,” I explained to Kevin as I worked.

I placed the suture using fine stainless steel suture material. Then I put a pressure wrap on the ear flap and wrapped it to Finn’s head so he wouldn’t flap his ears.

“Let me see Finn next week, and we will take things off,” I said. “He should be good to go at that time.”

Finn looked a little funny heading out the door, but he and Kevin were happy to go home.

We unwrapped Finn’s ear the following week, and the hematoma looked resolved.

“Let’s leave it unwrapped, and I will leave that tube in place for a few more days,” I said. “Just to see that Finn isn’t flapping that ear a bunch.”

“This has been so much easier than the last one,” Kevin said. “I will bring him back in three days.

“This one was easier because we did it much sooner,” I said. “This teat tube thing doesn’t work well on a large hematoma. Mainly because you can’t get all the clot material out of the wound. That clot material causes these ears to crinkle up like with your last dog.”

Three days later, I removed the teat tube, and Finn’s ear healed to its normal appearance.

Photo by Jaxon Castellan on Pexels.

Published by d.e.larsen.dvm

Country vet for over 40 years in Sweet Home Oregon. I graduated from Colorado State University in 1975. I practiced in Enumclaw Washington for a year and a half before moving to Sweet Home to start a practice.

3 thoughts on “The Ugly Pinna Hematoma 

  1. In my youth I spent 10 years as a competitive wrestler. During that time, I became well acquainted with hematoma of the ear. In my case, they all healed nicely with no lasting result. For my team mate Tony, exactly the opposite outcome. His ears took on the same appearance as Finn’s predecessor. But the truth is, those “cauliflower ears” were viewed with a degree of envy by other wrestlers. And knowing a bit about Blue Heelers, I would bet they feel the same way: a badge of courage, perhaps.


    1. In many initial planning of this story I was thinking of making a comparison between the dog and wrestlers. That obviously didn’t happen in the story, mainly because I try to keep these stories short.
      Over the years, I have known many dogs who carried a wrinkled ear as a “badge of courage,” and in most cases it fit their personality.
      Thanks for the comment, John.


      1. TK had a bunch of barn cats (rather feral ones, as there are 400ish of them on that large Canadiann property) with Cauliflower ears. One is in at tinykittens right now, El Jefe was in last week, and had TWO cauliflower ears. The one that is in now was described as having a gated mite community in his cauliflower ear. Shelly Roche isn’t shy when it comes to cleaning out ear mites out of cat ears. But with cauliflower ears she leaves that to her vet, Dr Ferguson, in Langley, British Columbia, and her Mountain View Vet clinic.

        Liked by 1 person

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