too small.” He has a special process of unwinding cotton from a cotton ball to increase the size of the Q-tip so it can hold more adrenaline and it will fit into a larger cut. “It’s important to dry the wound, use pressure and then Vaseline.” He believes that in most instances, the coagulant (clotting) effect will occur within the first few minutes and stop the bleeding. However, it is pressure that really stops bleeding. Dr. Nitin Sethi, the New York State Athletic Commission chief physician, says that referees and ringside doctors observe and always try to permit the cutman to work on the cut before considering stopping a bout. “Unless the referee calls a time-out and calls the doctor in, we would probably let the fight go,” he says. As for after a fight ends: “Most major events or promotions hire a suture doctor. We clear the fighter medically, then take them over to the suture doctor. I tell the fighter if they’re not comfortable with that physician, we can send them to the hospital for plastics (plastic surgeons) to repair.” Too often, beginner or club- show fighters can’t afford a trained cutman, and their corner shows up with nothing other than a Q-tip. This contributes to the risk of a stoppage or a poor performance. “Too many cornermen don’t have access to a prescription for adrenaline,” says Anber. He notes that at Riyadh Season events, the overseeing doctor provides sealed, single-use adrenaline bottles. Besides accessibility, this is ideal because it lessens risk of infection from a cutman using the same bottle on more than one fighter. New York also requires single-use bottles, but the cornermen must seek out the adrenaline prescription on their own. California chief physician and plastic surgeon Dr. Paul Wallace adheres to the 1% rule – meaning a laceration will heal 1% per day, assuming there are no other medical issues. So, for a cut to develop adequate tensile strength (the maximum amount of pulling or
When all attempts to control a serious cut fail, the fight must be stopped.
stretching the area can withstand), it can take 100 days. “There are four stages of healing: hemostasis (stopping the bleeding), inflammation (normal response of our body to injury), proliferation (wound is rebuilt with new healthy tissue) and maturation (where the body strengthens scar tissue). At 28 days, it is a critical time where new blood vessels are forming. Re-injury during that time can cause the wound to re-open.” There are risks that predispose a boxer to be cut. The skin’s outer layer is more susceptible to injury as we age, and wound healing can take longer. Genetics, heredity and anatomy can play a role. A prominent eye socket (bony area surrounding the eye) can increase the likelihood of bleeding when struck. Medical conditions like high blood pressure and diabetes increase risks. A prior history of a cut in the same area can predispose the fighters to be re-injured, especially if the laceration wasn’t properly sutured the first time or had inadequate time to heal. If the boxer is prone to scar tissue, the surrounding areas may be at more risk. It’s also crucial for a fighter to have a laceration repaired quickly to prevent infection.
THE FIGHT DOCTOR A CUT ABOVE By Dr. Margaret Goodman when applied to bleeding tissue, it activates the platelets in the blood to form a rapid clot. Thrombin: A topical enzyme that can also slow or stop bleeding. Handling cuts effectively takes many years of experience.
Medications can play a role. Anti- inflammatories like aspirin, Motrin (ibuprofen) and Aleve (naproxen) can worsen bleeding if taken too close to a bout. Performance-enhancing drugs like anabolic steroids will also increase bleeding. Alcohol also produces an increased susceptibility to bleeding and facial swelling. Good nutrition – not just when preparing for a bout – can prevent significant bleeding from a cut. Vitamin-rich fresh fruit and vegetables provide the necessary enzymes to boost the immune system, while dairy products and white flour can slow tissue regeneration and recovery. Vitamin E helps prevent scarring, while Vitamins C, B and A all promote healing and fight infection. Bottom line: Maintaining good health between bouts, not treating boxing as a hobby, wearing well-fitting headgear in training and having an experienced cutman will all decrease the likelihood of a cut interfering with a boxer’s performance and success.
T here will always be cuts in boxing, but when are they dangerous? When should a cut stop a fight? Is there a way to prevent them – other than the obvious? And does a good cutman make a difference? Few are more experienced than Dr. Michael Schwartz, chief ringside physician for professional boxing and MMA in Connecticut, who has worked in combat sports for almost 30 years. “Of course, location is important,” says Schwartz. “If the cut is impairing the fighter’s vision, they can’t adequately defend themselves. Or the laceration is sufficiently deep that permitting the bout to continue could cause permanent damage. “Too many don’t understand what we [ring physicians] are really assessing.
If you see a cut running down the side of the face, it’s typically not dangerous. If the cut is more medial-running along the side of the nose, then it could require a stop.” Cuts on the forehead or scalp – often caused by a headbutt – will bleed but are usually not dangerous. Cuts that are deep to the bone might stop a fight, but if there’s no blood vessels there, technically the fighter can continue. Bottom line: The ringside physician is not concerned with blood UNLESS it is affecting the fighter’s ability to protect themselves. There are three legal substances that can be used in the corner during a fight: Adrenaline (epinephrine), 1/1000 concentration: Causes the vessels to constrict and therefore reduces bleeding. Avitene: Made up of collagen fibers;
Rarely, a cornerman will illegally try to use some type of skin glue, but it won’t work on freshly bleeding tissue. Furthermore, during the fight, the wound isn’t sterile or dry. As a result, it contributes to the bleeding. Russ Anber, one of the best-known cutmen today and soon to be inducted into the International Boxing Hall of Fame, stresses the importance of calmness and keeping composure between rounds – especially when there’s a cut. “There’s only so much you can do in the one minute between rounds,” says Anber, who has worked for Oleksandr Usyk and Vasiliy Lomachenko, among many others. “I use only adrenaline 1/1000 and make my own Q-tips. The Q-tips you buy are
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