Aural haematoma (AH) is a prevalent disorder of the external ear, defined by the collection of blood between the auricular cartilage and the overlying skin (Vigneswari et al., 2023). Aural hematomas in dogs seem to be triggered by diseases involving the hearing system that cause sudden head movements because of pain, pruritus or otitis (Rodrigues et al., 2016). The objective of both surgical and conservative treatment approaches is to evacuate the accumulated blood from the auricle and to inhibit subsequent fluid formation (Brown, 2010). Delayed intervention may result in hematoma maturation and fibrin deposition. Prolonged cases can progress to fibrosis, ultimately causing structural deformities of the ear (Rodrigues et al., 2016). The management of aural haematoma (AH) varies depending on the severity of the condition and the efficacy of available treatment options. Common approaches include fluid aspiration, aspiration combined with dexamethasone administration and surgical intervention. Among these, surgery is the most frequently employed method, as it not only minimizes the risk of recurrence but also helps preserve the natural structure and cosmetic appearance of the ear pinna (Feyisa et al., 2020; Hall et al., 2016). In this research, comparative study was done between conventional through and through mattress suture technique and use of bio-adhesive gel for treatment of aural haematoma in dogs.

This study was conducted on 24 clinical cases of aural haematoma presented to the Veterinary Clinical Complex and the Department of Veterinary Surgery and Radiology, College of Veterinary Science and Animal Husbandry, Odisha University of Agriculture and Technology, Bhubaneswar. The cases were sourced from various geographical and topographical regions of the state, managed by different owners, between October 2023 and November 2024. Animals of both sexes, representing various breeds and ranging in age from 2 to 13 years, were included in the study (Table 1).


       
A routine physical examination was conducted, including assessment of the shape and size of the haematoma. The length, width and thickness of the swelling were measured using a slide caliper (Fig 1). Observations were also made for any local or systemic dermatological conditions, as well as ectoparasitic infestations such as ticks, mites, or fleas. Clinico-physiological parameters namely rectal temperature (°F), respiratory rate (breaths/min), heart rate (beats/min), pulse rate (beats/min) and the condition of the visible mucous membranes (palpebral conjunctiva) were recorded on days 0^th , 4^th , 8^th and 12^th of the postoperative healing period. Haemato-biochemical analyses were also performed. Radiographic imaging of the head and ear canal was carried out in dorsoventral and lateral views to detect any concurrent involvement of the ear canal. Ultrasonographic examination of the aural haematoma was performed to evaluate the presence and extent of blood clot formation (Fig 3). Additionally, otoscopic evaluation of the ear canal was done to identify any associated conditions such as neoplasms, otitis externa or the presence of foreign bodies (Fig 2). Following comprehensive assessment of these parameters, the animals were subjected to surgical intervention.






       
The animals under this study were divided into three groups i.e. Group-I (animals treated only with conventional through and through mattress suturing without application of prepared collagen adhesive gel), Group-II (animals treated only with prepared collagen adhesive gel without suturing) and Group-III (animals treated with application of prepared collagen adhesive gel along with conventional through and through mattress suturing) (Table 1).
       
The collagen-based bioadhesive wound healing formulation was prepared using tranexamic acid (5% w/w) and ciprofloxacin hydrochloride (0.2% w/w) in a topical gel incorporating collagen crystals. The gel base was formulated with oxidized guar gum (10% w/v) and gelatin (10% w/v). Gelatin, tranexamic acid and ciprofloxacin HCl were dissolved in warm distilled water, while the required quantity of oxidized guar gum was separately dissolved in distilled water at room temperature. The oxidized guar gum solution was then thoroughly blended with the gelatin-tranexamic acid-ciprofloxacin HCl mixture using a homogenizer (Remi Motors, Remi Elektrotechnik Ltd., India) at 600 rpm. Glycerin (5% w/w) was added as a humectant during the mixing process to achieve a uniform and homogeneous gel. The final formulation was stored under refrigeration for 24 hours prior to evaluation.
       
All animals were subjected to a 12-hour preoperative fast from solid food, with water withheld for 6 hours prior to administration of general anaesthesia. Preoperative analgesia was provided with meloxicam (Inj. Melonex) at a dosage of 0.2 mg/kg body weight. Anaesthetic induction was achieved using a combination of atropine sulphate (0.04 mg/kg bwt), xylazine (1 mg/kg bwt) and ketamine (5 mg/kg bwt) intramuscularly. Anaesthesia was maintained intraoperatively with supplemental doses of ketamine as required.
       
The animals were positioned in lateral recumbency with the affected ear facing upward. A sterile cotton plug was inserted into the external auditory meatus to prevent drainage of haematoma fluid into the ear canal. The external ear was initially cleansed using a solution of chlorhexidine gluconate and cetrimide (Savlon liquid). The hair over the pinna was removed with a shaving blade, followed by repeated cleansing of the surgical area (4-5 times) using the same antiseptic solution. Subsequently, a 5% povidone-iodine solution (Betadine lotion) was applied to the surgical site and surrounding area to ensure aseptic conditions.
       
A longitudinal incision of appropriate length, based on the size of the aural haematoma, was made over the swelling on the concave surface of the ear using a Bard Parker (BP) blade No. 24. The clotted blood and debris were evacuated and the haematoma cavity was thoroughly cleaned multiple times with sterile gauze. The cavity was then flushed with a 5% povidone-iodine (Betadine) solution.
       
In Group-I, multiple through-and-through mattress sutures were placed parallel to the incision line using the conventional technique, with knots secured on the convex surface of the ear pinna. In this group, suturing was performed without the use of the prepared collagen-based adhesive gel. A pressure bandage was applied over the operated ear, ensuring that the concave surface remained upward. The bandage was removed after four days and routine wound dressing was carried out until postoperative day 10^th to 14^th, depending on the individual case.
       
In Group-II, the prepared bioadhesive collagen gel was aseptically loaded into a sterile 2 ml dispovan syringe and injected into the haematoma cavity (Fig 4). The gel was evenly distributed throughout the entire pocket using digital pressure. The incision site was left unsutured (Fig 5). A pressure bandage was applied over the operated ear with the concave surface oriented upwards (Fig 6). Dressing changes and rebandaging were performed at four-day intervals, with two to three rebandaging sessions required depending on the individual case.






       
In Group-III, the bioadhesive collagen gel was thoroughly distributed within the haematoma cavity by applying digital pressure. Subsequently, multiple through-and-through mattress sutures were placed parallel to the incision line using the conventional technique, with knots tied on the convex surface of the ear pinna. A pressure bandage, consisting of a 6-inch gauze wrap, was applied over the treated ear, maintaining the concave surface in an upward position. The bandage was removed four days post-surgery, followed by regular wound dressing until postoperative days 10^th to 14^th, depending on the individual case.
       
Postoperatively, ceftriaxone combined with tazobactam was administered intramuscularly at a dosage of 25 mg/kg body weight once daily for five days. Meloxicam was given at 0.2 mg/kg body weight for three days across all cases. Owners were instructed to use appropriately sized Elizabethan collars to prevent self-trauma.
       
The gross physical characteristics of wounds at various sites, as well as the progression of wound healing, were assessed in all three groups on days 0^th, 4^th, 8^th and 12^th post-surgery (Fig 7-12). Evaluations were conducted using a subjective scoring system based on a 0-3 scale to quantify wound healing parameters (Table 2).














       
The total duration required for complete wound healing was recorded for all three groups. Any occurrences of wound dehiscence were documented and managed appropriately. Following complete healing of the aural haematoma, the cosmetic outcomes such as normal appearance, drooping, or wrinkling of the ear were assessed and analyzed across the groups. Photographic documentation was performed on days 0^th, 4^th, 8^th and 12 post-surgery for evaluation purposes. Additionally, the operated dogs were monitored for a period of 4 to 6 months to observe any complications or recurrence of the condition.
       
Mean and standard error (SE) were computed for all parametric data. Hematological and biochemical parameters were evaluated by one-way analysis of variance (ANOVA) followed by Tukey’s post hoc test. Wound healing parameters were analyzed using the Kruskal-Wallis test followed by Dunn’s multiple comparison tests. Differences were considered statistically significant at p<0.05.

Rectal temperature, respiration rate and pulse rate remained within normal limits throughout the study, with no significant differences observed either between groups or across different time points. Hematological parameters, including hemoglobin (Hb), packed cell volume (PCV), total erythrocyte count (TEC), total leukocyte count (TLC) and differential leukocyte count (DC), were also maintained within normal ranges across all groups (Table 3,5,7 and 9). Similarly, biochemical markers such as alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine and blood urea nitrogen (BUN) showed no significant variations among the groups (Table 4, 6, 8 and 10).
















       
The duration of the surgical procedure, measured from the initial incision to skin closure, was 19.2±0.36 minutes in Group I, 2.02±0.2 minutes in Group II and 22.42±0.64 minutes in Group III. The significantly shorter operative time in Group II is attributed to the absence of suturing, which streamlined the procedure. These findings are consistent with the observations reported by Prarthana et al., (2023).

No significant differences were observed in the type of exudate among the groups on Day 0. However, by Day 8, the mean±SE values for exudate type were 1.25±0.15 in Group I, 0.67±0.21 in Group II and 0.82±0.11 in Group III, with a statistically significant difference detected among the groups (P<0.05). By Day 12, the mean±SE values had decreased to 0.16±0.11 for Group I and 0.00±0.00 for both Group II and Group III, again showing a significant intergroup difference in wound exudate characteristics (P<0.05) (Table 11).


       
No significant differences in the extent of exudate were observed among the groups on Day 0. However, by Day 8, the mean±SE values for extent of exudate were 1.00±0.00 in Group I, 0.65±0.15 in Group II and 0.77±0.11 in Group III, with statistically significant differences noted between the groups (P<0.05). On Day 12, the extent of exudate further decreased, with values recorded as 0.25±0.15 for Group I, 0.00±0.00 for Group II and 0.09 ± 0.11 for Group III. These differences were also statistically significant (P<0.05) (Table 12). These findings are supported by Sharma et al., (2025).


       
On day 8, mean±SE of degree of swelling was recorded to be 1.12±0.11 for group-I, 0.50±0.17 for group-II and 0.87±0.11 for group-III. There was a significant difference observed on 8^th day in degree of swelling in surgical wound (P<0.05). On day 12, mean±SE of degree of swelling was recorded to be 0.37±0.17 for group-I, 0.00±0.00 for group-II and 0.15±0.15 for group-III. There was no significance difference in degree of swelling between the groups on Day 12 (P>0.05) (Table 13).


       
On Day 8, the mean±SE values for wound contraction were 2.17±0.17 in Group I, 2.75±0.15 in Group II and 2.57±0.17 in Group III, with a statistically significant difference observed among the groups (P<0.05). By Day 12, wound contraction had further progressed, with values of 2.05±0.15 in Group I, 3.00±0.00 in Group II and 2.87±0.11 in Group III. These differences remained statistically significant (P<0.05) (Table 14).


       
The mean ± SE duration of wound healing was recorded as 11.82±0.17 days in Group I, 10.05±0.23 days in Group II and 10.75±0.34 days in Group III. A statistically significant difference in healing duration was observed among the groups (P<0.05) (Table 15). This is supported by Hafiz et al., 2018 and Ahmad et al., 2024. Quicker healing in Group-II may be due to collagen’s efficacy in promoting fibroblast proliferation and cellular regeneration, as well as its role in reducing inflammation and supporting tissue structure during healing. This is supported by Jain et al., (2023) and Preethi et al., (2021).


       
Cosmetic appearance, in term of minimal scarring, deformity, wrinkling or erection of ears, was excellent in Group-II (application of collagen bio-adhesive only) as compared to other two groups. Dogs with smaller ear pinna exhibited more favorable outcomes when treated with collagen bio-adhesive gel alone. In cases of incomplete or partial aural haematomas, effective management can be achieved using the collagen bio-adhesive gel without the need for conventional through-and-through suturing. However, in cases involving complete or extensive aural haematomas affecting the entire ear, a combination approach utilizing both through and-through mattress suturing and collagen bio-adhesive gel yielded superior results. These findings are consistent with the observations reported by Hafiz et al., (2018).
       
Wound dehiscence was observed in one animal from Group II, where premature removal of the bandage by the dog led to disruption of the healing site. This was successfully managed through rebandaging, consistent with the findings of Eyarefe et al., (2013). Additionally, the treatment of acute aural haematomas resulted in more favorable cosmetic outcomes compared to chronic cases, where prolonged inflammation contributed to fibrosis, causing marked thickening and deformation of the ear pinna, as noted by Pavletic (2015).

Wound healing was most rapid in Group II animals (treated with collagen bio-adhesive gel without suturing), followed by Group III (treated with both collagen bio-adhesive gel and through-and-through mattress sutures) and was slowest in Group I (treated using the conventional through-and-through mattress suture technique). The cosmetic outcome assessed in terms of reduced scarring, deformity, wrinkling, or ear elevation was superior in Group II compared to the other two groups. Dogs with smaller ears demonstrated more favorable responses to treatment with collagen bio-adhesive gel alone than those with larger ears. Partial or incomplete aural hematomas can be effectively managed using collagen bio-adhesive gel alone, offering a viable alternative to traditional through-and-through suturing. However, in cases of complete or extensive aural hematomas, including those involving the entire ear, a combination approach incorporating both the mattress suturing technique and collagen bio-adhesive gel yielded improved therapeutic outcomes.

The authors are thankful to the Dean, College of Veterinary Science and Animal Husbandry, OUAT, Bhubaneswar for providing necessary support during the research.

On behalf of all the authors, I declare no conflict of interest regarding publication.