aural haematomas

Re: aural haematomas

Martin Atkinson — Tue, 12 Aug 2014 11:00:32 GMT

[quote user="Tim Browning"]We have been trying some little plastic ear stents that are inserted (conscious if lucky or v quick GA) via a stab incision and allow drainage.[/quote]I've just got some of these and may well try them on the dog that failed with surgical technique, that's if Pet Plan pay up the direct claim for the surgery which they haven't yet 5 weeks on - meanwhile the haematoma is just getting more and more organised!

As they didn't come with instructions I was wondering how the little tabs on the drain worked - whether you buried them or used them to suture to the skin. Assuming they are the same ones, do you leave the cap off or remove it intermittently to allow controlled drainage?

Re: aural haematomas

Tim Browning — Tue, 12 Aug 2014 10:53:13 GMT

We have been trying some little plastic ear stents that are inserted (conscious if lucky or v quick GA) via a stab incision and allow drainage. These are surprisingly effective for huge neglected haematomas. Smaller ones respond well with steroids alone. They can be removed with a sharp tug after a week or so. They are certainly time savers and very little deformation results. We will continue our trial.

Re: aural haematomas

Anthony Dennison — Tue, 12 Aug 2014 08:21:20 GMT

[quote user="Anthony Todd"]

[quote user="Gareth C."]Penrose drain tomorrow[/quote]

Make sure you warn the owner of pinna distortion.

[/quote]

As a recent grad, the penrose drain method of dealing with aural haematomas is the only one I have really used. I haven't had a problem with distorted pinnae yet.

Re: aural haematomas

Anthony Todd — Mon, 11 Aug 2014 21:14:44 GMT

[quote user="Gareth C."]Penrose drain tomorrow[/quote]

Make sure you warn the owner of pinna distortion.

Re: aural haematomas

Gareth C. — Mon, 11 Aug 2014 17:08:58 GMT

thanks for all the replies to my post. interesting selection of techniques and opinions!! Penrose drain tomorrow

Re: aural haematomas

Anthony Todd — Mon, 11 Aug 2014 16:11:08 GMT

[quote user="Martin Atkinson"]This approach has served me well over many years [/quote]

Show us the full frontal pictures and we'll see why buttons aren't as good as a plastic milk bottle splint which does the same thing as buttons but retains the shape of the pinna perfectly. I left the splint/milk bottle on for 6 weeks by which time healing is complete with no breakdowns.

Three weeks isn't enough IMHO.

I wish someone would try it, 'cos the results are perfect.

As another well known and opinionated poster has said on another topic ,to say Depomed is "evil" , is nonsense.

Re: aural haematomas

Martin Atkinson — Mon, 11 Aug 2014 15:39:22 GMT

[quote user="Derek Lyon"]

Why is use of Depomedrone evil?

[/quote]Do you really need an explanation why using depo-steroids is bad? If so its as well you left practice although Anthony will agree with you!

Re: aural haematomas

Derek Lyon — Mon, 11 Aug 2014 15:07:48 GMT

Why is use of Depomedrone evil?

Re: aural haematomas

Martin Atkinson — Mon, 11 Aug 2014 15:01:02 GMT

In answer to the OP the pads are simply called haematoma pads and should be available from veterinary wholesalers.

To add to the debate I've tried every method under the sun over the years including benign neglect, the aforementioned pads, X-ray film, drains, splints etc etc and have come to the conclusion that they are best treated by draining after they've had chance to stabilse a little and the bleeder has hopefully stopped bleeding (usually about a week) but before there is an organised clot, then injecting Depomedrone (which before you mention it Anthony is the only use of this evil product in my practice)! If that fails I suture the two sides flat using buttons for 3 weeks which allow the ear to maintain a natural shape.

This approach has served me well over many years until the latest one which has developed another haematoma after the sutures were removed. Doesn't help it is also atopic so its ears are very itchy to start with.

Re: aural haematomas

Anthony Todd — Sat, 09 Aug 2014 18:04:27 GMT

[quote user="Derek Lyon"]

I know it is years since I was in practice but I always treated such cases by draining the haematoma via small gauge needle and then injecting Depomedrone into the space left. Always had great results without resorting to surgery. Just my 2 pennith!

[/quote]

I agree totally, but not if it's the whole pinna, just for a "partial" haematoma.

The accepted method ,back in the day ,was a long medial incision right down the pinna or "make what we surgeons call a big 'ole to drain the fluid " and squeeze out the clot which inevitably scarred massively and distorted the ear.

Re: aural haematomas

Derek Lyon — Sat, 09 Aug 2014 17:30:29 GMT

Re: aural haematomas

Anthony Todd — Sat, 09 Aug 2014 16:31:01 GMT

I forgot ;the drain merchants have to deal with the inevitable head shaking and resultant splatter pattern all over the Farrow & Ball.....

Never had to E. collar one of mine, used a plastic template instead of a plastic bucket.

Re: aural haematomas

Evelyn Barbour-Hill — Sat, 09 Aug 2014 14:15:12 GMT

[quote user="Stephen Courtney"]The surgery is a horrible mess, creates problems especially in warm weather and means an e collar for some time so I prefer to avoid it.[/quote]

While, like others here, I hardly ever "operate" upon aural haematomata these days and prefer masterly inaction, I have done many by the incision and pad method in the past. I must say I disagree completely with your third and first assertions and I'm not at all sure about the middle one.

Re: aural haematomas

Anthony Todd — Sat, 09 Aug 2014 12:32:45 GMT

[quote user="Sammy82"]I think it is really important to discuss the clients expectations and wishes. Do the owners care about the appearance? Obviously in a show dog or if the owner wants the best possible cosmetic result operating and splinting is the way to go if it refills after 1-2x draining. But in a farm dog or an old lumpy dog owners should be aware that the cheap option of draining it initially to relieve the discomfort, and then leaving it to organise, accepting a cauliflower ear is perfectly acceptable.[/quote]

See Malcolm, someone else realises reality...

Re: aural haematomas

Anthony Todd — Sat, 09 Aug 2014 12:30:57 GMT

[quote user="Malcolm Ness"]Trouble is, that statement is nonsense - you didn't believe me last time and you won't believe me this time.[/quote]

Snap, I could say the same thing about the above. You may not believe me, but I have done more than one. You can develop a successful treatment without writing it up you know.

Unless you only see really early haematomata affecting only part of the pinna and then most of those, if they don't progress, do fine with the drain and steroid approach.

This is what I said last time:

Can't argue with that unless I fall back on peer-reviews an' all.

It certainly sounds much simpler, but I'd love to see a few full frontal head shots of cats or prick eared dogs 3 months after your procedure and mine....

Some do well on drain by needle and depomed instilled [and correct the irritation ie mites in cats, usually].

But I never saw the full frontals, did I?......

I've seen loads of really distorted crumpled ears, particularly in cats; they used to be very common.

Re: aural haematomas

Sammy82 — Sat, 09 Aug 2014 12:27:10 GMT

I think it is really important to discuss the clients expectations and wishes. Do the owners care about the appearance? Obviously in a show dog or if the owner wants the best possible cosmetic result operating and splinting is the way to go if it refills after 1-2x draining. But in a farm dog or an old lumpy dog owners should be aware that the cheap option of draining it initially to relieve the discomfort, and then leaving it to organise, accepting a cauliflower ear is perfectly acceptable. I think far to often vets and owners alike are worrying too much about an essentially cosmetic problem and the underlying medical condition, e.g. Otitis ext.poss contralateral, is overlooked and neglected. I would also advise against putting a dog with an increased GA risk under for a cosmetic procedure.

Re: aural haematomas

Rob Reid — Sat, 09 Aug 2014 12:23:05 GMT

[quote user="Anthony Todd"]This happens definitely permanently and completely if you let the haematoma "organise", just look at any rugby forward![/quote]

Most rugby forwards playing at a higher level I believe get their haematomas needle drained after the match. I can't speak for lower level rugby players now, I know from when I briefly played some would self-drain, some would go the doctor/nurse, some would leave. However, the degree of repeat trauma, and the time period over which this occurs ie many years is far more substantial than a pet so I think your statement is actually pretty irrelevant in the veterinary context.

Perosnallly, I've never had any issues with the cosmetics of the penrose drain technique on the occasions I've needed to use it and the opinions of my clients have reflected this. I used to do these using the incision and suture technique and the cosmetics were worse with this and they did end up a horrible sticky mess after a few days.

And anyway, surely the cosmetics aren't actually that important - isn't it improving the welfare of the patient that is the key?

Re: aural haematomas

Malcolm Ness — Sat, 09 Aug 2014 11:16:59 GMT

[quote user="Anthony Todd"]Trouble is, with all of the above methods, is that unless you splint the ear accurately you end up with a very distorted ear.[/quote]

Trouble is, that statement is nonsense - you didn't believe me last time and you won't believe me this time.

Drain; place penrose drain and use pred for a couple of weeks and the "haematoma" resolves with excellent cosmetic results in most cases.

Check out the literature and if your experience is different then write it up and publish it.

Re: aural haematomas

Anthony Todd — Sat, 09 Aug 2014 11:08:19 GMT

[quote user="Rob Reid"]

Good thread on this a while back

http://www.vetsurgeon.org/forums/t/10504.aspx?PageIndex=1

Personally, I very rarely operate on these and never just drain them. I only operate if the whole pinna is involved or the dog/cat is very bothered by it, in which case I use the penrose drain technique. If I'm not operating, I want the haematoma to 'organise' - draining just prevents this and prolongs the process I find. I'll tend to use an oral corticosteroid with either surgical or conservative management as evidence (JSAP paper) does point to better outcomes with usage and my experience certainly mirrors this.

[/quote]

Trouble is, with all of the above methods, is that unless you splint the ear accurately you end up with a very distorted ear.

The old advice of an incision right down the inside of the pinna caused massive scaring and distortion, much to the disgust of prick eared dog owners...

The correct plastic "splint", and it must be exact, gives a perfect result, is well tolerated by the animal and should be trouble free.

Can use flat plastic on flat pinnad dogs like cockers.

I think I've said all this in the previous thread? Yes page 7 and I stand by it still.

This time I've emphasised the essentials for success, to which I add again "drain with the smallest hole you can so you get the smallest amount of scaring and resultant permanent distortion of the pinna.

This happens definitely permanently and completely if you let the haematoma "organise", just look at any rugby forward!

Re: aural haematomas

Rob Reid — Sat, 09 Aug 2014 09:53:25 GMT

Good thread on this a while back

http://www.vetsurgeon.org/forums/t/10504.aspx?PageIndex=1

Re: aural haematomas

Stephen Courtney — Sat, 09 Aug 2014 07:58:17 GMT

Personally i try to avoid surgery on these unless essential. I use pink IV catheter to drain the pocket slowly - you get much more out than with suction if you let it drip and apply gentle pressure - then instil a bit of dexafort into the cavity . warn owner it will refill, and likely redrain again in 5-7 days. I usually don't drain more than twice.

The surgery is a horrible mess, creates problems especially in warm weather and means an e collar for some time so I prefer to avoid it.

Re: aural haematomas

Anthony Todd — Fri, 08 Aug 2014 18:51:53 GMT

[quote user="Andrew Kent"]They come from Kruuse, see[/quote]

Or you could cut a mould from a plastic bottle punch the holes and DIY; works a treat.

Re: aural haematomas

Andrew Kent — Fri, 08 Aug 2014 18:45:32 GMT

They come from Kruuse, see

http://www.kruuse.com/en/ecom/Forbindsstoffer_sår/Primær_forbindinger/Othaemat_komp_primær/prod_161640.aspx

always hated them myself!

Andy