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12 NOVEMBER 2018


Management of hematomas – The proper use of Enswell

By Dr. Domenic F. Coletta

Recently while working a heavyweight fight in Atlantic City, I was called to the ring by the Referee in the eighth round to evaluate a large hematoma (swollen area of skin) on a particular boxers head. A hematoma, a common result of traumatic contact with the soft tissue on the body, is basically a collection of blood under the skin. Usually, when this occurs in a sporting contest, the swelling remains somewhat stable and contained with the proper application of ice and pressure.

In this boxer’s case, however, the hematoma expanded quite rapidly from the seventh to eighth round, prompting the decision to stop the fight as it seemed to be affecting the boxer’s vision. Initially, I believed that the dramatic increase in size of this mass was directly a result of continued punches to that area of the forehead by the opponent following an accidental head butt that caused the initial insult. However, in viewing the videotape of the boxing match, I am convinced that the improper use of Enswell played a significant role in the problem.

Enswell is a fantastic product and should be a standard piece of equipment for all corner men as it has certain advantages over more flimsy “meltable” ice packs. However, all too often I have observed the overly aggressive cut man applying Enswell with great pressure and moving it across the hematoma in an effort to “flatten out” the swelling.

This maneuver can instead actually make the situation worse by disrupting the microscopic blood vessels under the skin thus causing an increase in the bleeding and enlargement of the hematoma.

Enswell or ice should be applied with moderate steady pressure against the site of the swelling for the most effective treatment of this common dilemma in boxing.


Dr. Domenic F. Coletta practices in Atlantic City, New Jersey where he has been a licensed ringside physician since 1988. His medical specialty is in the field of emergency medicine and he is on the medical executive board of the American Association of Professional Ringside Physicians (AAPRP). All of the views, opinions, and/or recommendations contained herein are solely his own and do not necessarily reflect those of the New Jersey State Athletic Control Board or the AAPRP.

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