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25 APRIL 2014

 

Cuts …..to stop or not? Part I


by Margaret Goodman, MD

As a boxing fan, how many times do you sit there and wonder WHY a doctor let a bout continue, and other times WHY they stopped the contest? As a ring doctor I, myself, wonder a great deal of the time. So, I know boxers, cornermen, and TV commentators must face the same quandaries. What is the answer…..or is there a right answer? Unfortunately, if things were this simple there would never be any controversies. Things would be a great deal less interesting, but there would be consistency. No fight is the same, no two fighters are the same, no doctor is the same, and each cut is different. However, there are some rules we can follow.

Cuts are rarely stopped on their own merit. A cut should stop a fight if it is 1) giving the opponent an unfair advantage; 2) allowing the fight to continue could cause irreparable damage to the boxer; or 3) the boxer is losing nearly every round AND taking blows to the head. Deep cuts are dangerous in the sense that they can necessitate the use of a plastic surgeon, an operating room repair, intravenous antibiotics/hospitalization, and a drain hanging out of the laceration for a few days. You want a fighter to not have to take too much time off after a fight, especially if he is just beginning his career.

The most common place for a fighter to get cut is around the eye; usually just below the bony brow. If it is on the eyebrow, it is usually not an issue. If lower, you have to evaluate the depth. If a cut of this nature becomes too deep it could affect the eye muscles that move the eye and result in double vision, or if too severe could lead to ptosis(drooping eyelid). Furthermore, if this type of laceration is close to the inside corner of the eye, it could injure the tear duct (causing a dry eye and frequent infections). If a cut below the brow is in the crease of the eye, or more importantly on the part of the lid that covers the eyeball, these are dangerous, and there is no discussion. Below the eye (lower lid) close to the eyelashes is very difficult to repair. If allowed to continue, the boxer might require surgery. Even then scarring could produce an eye that doesn’t close properly (like a Basset Hound). When checking a cut around the eye, the doctor is also making certain the fighter can see. A laceration from a punch or butt can sometimes injure the eyeball itself or occur along with a fracture of the orbit (eye socket). This is certainly a reason why a cut may not look deep, yet the ring doctor has to stop the fight.

Cuts on the forehead or scalp are usually the result of a head butt. Although these are often deep, they rarely require a stop. Exceptions are if blood is obstructing the boxer’s vision or there is way too much blood loss. Cuts right above the brow (if deep) can affect the ability to lift the eyebrow. These need to be watched closely as they could result in permanent disfigurement.

Blood from the ear is pretty uncommon in a fight. It can have serious consequences. It can represent a busted eardrum and perhaps even a basilar skull fracture (a fracture at the base of the skull). The doctor needs to try to assess where the blood is coming from. If this can’t be done easily between rounds, the fight should stop.

Lacerations to the cheek (deep or superficial) are usually little to worry about. Arturo Gatti had a nasty cheek gash while fighting Oscar de la Joya. It looked bad, didn’t affect his performance, and was easily sutured after the fight.

Nasal problems will be handled in a different article. However, sometimes a fighter is cut across the nose. Typically this is no problem, unless the fighter ALSO appears to have a broken nose. The two together means an Open Nasal Fracture until proven otherwise. This requires surgery and a few months off.

Lastly, bleeding around the mouth can often be from the nose. Not a problem unless it causes nausea. More than a few of us saw poor Robbie Peden vomit on "HBO After Dark" from swallowing too much blood. However, if the fighter has a cut on the tongue (received from an open mouth, badly fitting mouthpiece, and a punch), or on the inside lip, these can bleed profusely and the bout must stop. If the laceration involves the Vermillion border (the line between the lip and face), these are very difficult to correct with stitches. The fight should stop as letting it go could produce scarring which might prevent the mouth from closing properly.

So, now we have it all figured out!

Sorry, no such luck.

Of course, some cuts eliminate any discussion. In truth, many other factors enter into the absolute decision. If the cut occurs in the last few rounds of a ten-rounder or championship bout, as long as the fighter isn’t taking too much punishment, you allow him to continue. On the other hand, if the fighter is just beginning his career, he is in a four rounder and has a big gash, you would be inclined to get that guy out of there. You want the fighter to not have to take too much time off from the gym and resume their career. Allowing a cut to get too deep necessitates weeks, if not months, off. This isn’t good for a young boxer just starting out. Experience counts a great deal. It is fascinating to watch a fighter who has never been cut before. Some boxers simply fall apart the first time they get cut. They forget they ever had a game plan and have problems continuing. Older, more experienced fighters are often indifferent to being cut in a fight. They handle it well and the doctor can relax.

What makes a cut bleed? Some areas on the face are more vascular than others. A cut doesn’t have to bleed to be serious. The contrary is also true. Some fighters bleed more when they have been using anti-inflamatories like Aspirin, Advil, or Motrin. Tylenol is the only anti-inflammatory that doesn’t lengthen the bleeding time, and is therefore safe for a boxer with an upcoming fight. Lastly, fighters that bleed a lot have often been cut before in the same place. The first laceration wasn’t allowed to heal long enough, so they bleed again.

A good cutman can be the best investment for an up and coming boxer. Their job is crucial to a fighter’s success in the ring. How to handle facial swelling, and stop a cut or the nose from bleeding will be handled in an upcoming article.

In the end, just like the rest of medicine….and boxing, THERE ARE EXCEPTIONS TO EVERYTHING! Hopefully, this will let you in on just some of the things the ring doctor thinks about when examining a cut during a fight.

****Boxing is a blood sport. No fighter should enter the ring before testing negative for Hepatitis B/C and HIV. Note: immunization can be given for Hepatitis. Consult your local athletic commission if questions.

_______________________________________________________________________

Look for PART II: Handling Cuts, Bleeding, and Facial Swelling in the Ring

by Dr. Flip Homansky

_________________________________

Dr. Margaret Goodman is a Ringside Physician and Chairman of the Medical Advisory Board of the Nevada State Athletic Commission.

Dr. Margaret Goodman practices in Las Vegas, Nevada, where she is a licensed ringside physician since 1994. Her medical specialty is in the field of Neurology. Dr. Goodman was appointed by Nevada’s Governor, Kenny C. Guinn, in September of 2001, to serve as Chairman of the Medical Advisory Board to the Nevada State Athletic Commission. Although she is Chairman of the Commission’s Medical Advisory Board, all of the views, opinions, and/or recommendations contained herein are solely her own and do not necessarily reflect those of Nevada’s Commission. All readers are strongly cautioned that the information contained herein is not intended to, and never should, substitute for the necessity of seeking the advice of a qualified medical professional whenever a boxer or his/her representatives have specific questions regarding the best course of action that a boxer should take. Furthermore, since it is possible that general information herein may pertain only to a law, regulation, rule or acceptable standard of practice for a particular jurisdiction, a boxer or his/her representatives must always inquire with the appropriate licensing jurisdiction to determine the applicable laws, regulations, rules, and acceptable standards of practice for each jurisdiction.

All readers are advised that the information herein is intended solely as a general reference source, and to the fullest extent permitted by law, the information is provided “AS IS” without any warranties of any kind, whether express or implied, including without limitation, warranties of merchantability, fitness for a particular purpose and non-infringement. No one may rely on the accuracy, integrity, quality or completeness of the general information herein. Accordingly, neither the authors, editors nor anyone else affiliated with this website may be held liable for damages of any kind whatsoever allegedly caused or resulting from any such claimed reliance.



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