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03 SEPTEMBER 2014

 

The magic of the cut man…or how I learned how to apply pressure to a laceration


By Flip Homansky MD

The cut man has now been elevated to the level of rock star. He brings magic potions and salves and his deeds are valued by all at ringside. The wondrous weapons of his trade (the Q tip and enswell) are in evidence for all to see. He even usually dresses in a way that distinguishes his art. What in the hell is he actually doing to the cut? What does work to stop bleeding, and what is legal? How important is a good cut man, and must he inflict pain to be effective? I am going to try to answer these and other pressing questions that you didn’t even know you asked.

A good cut man is invaluable to every fighter. He can truly be the difference between winning and losing. I have seen countless fights that were stopped because no one in the corner knew how to prevent a simple cut from getting worse. This is most obvious in many undercard fights, women’s bouts, and mixed martial arts contests. If I was a young fighter, I wouldn’t skimp on three things; my mouthpiece, my cup, and my cut man.

How should a competent cut man be chosen? Look for experience, someone who is calm, and talk to other fighters about who is good. There are a number of physicians who do an excellent job in the ring, but an MD degree is no guarantee that the holder knows a damn thing about jagged lacerations that are acutely bleeding. The ring is the most unlikely operating room that I can imagine. I would also worry about the guy who has so many Q tips in his mouth that he may choke at any time. Another concern of mine is the cut man with so much Vaseline on his body that he will slip getting into the ring and slide across to the other side. This would indeed be poor form!

This is not a new art. There have always been people in the corner who understood bleeding, and how to stop it. Yes Martha, there was a cold flat piece of ice before there was an enswell. Fights in the old days were longer, and frequently more brutal. When lacerations occurred, they were stopped by pressure (preferably cold pressure), and adrenaline. The current armamentarium is more extensive...but the cut man shouldn’t forget the basics.

A) Minimize the use of drugs that make bleeding more likely.

Aspirin (effects on platelets are profound and long lasting) as per Dr. Goodman.

Advil, motrin and aleve are all essentially the same.

Steroids will make skin thinner and definitely increase chance for bleeding.

B) Know your fighter.

You should be aware of prior lacerations and how the fighter reacted to his own blood. Any old laceration should be checked, and a fighter should not be hurried back into the ring until there has been relatively complete healing (more on suspensions in a future article).

If he or she has sustained any swelling or abrasions during training - address those before the actual fight begins.

C) Watch the fight closely for any signs of trouble that could be a prelude to a cut.

You don’t have to wait to see blood before you begin to treat an area of concern.

D) Understand the anatomy of the face, including the difference between arteries and veins.

Will be addressed in more detail in the future.

E) PRESSURE.

This is the key to stopping all bleeding.

Time is important here, and you must begin treatment immediately after the fighter reaches his corner. Don’t get in the way of the trainer...but be ready to do what must be done. The trainer can give instructions from the side, but you have to be in position to see the face completely. Firm, continuous pressure will begin the process of stopping the bleeding.

F) COLD.

Cold is a natural vasoconstrictor; that is, it will make blood vessels constrict or narrow.

This process will decrease the amount of blood going into the field of the cut.

The ENSWELL is nothing more than a flat or molded piece of metal that can be kept in ice and used to apply firm direct cold pressure to a laceration.

One of my biggest concerns about cut men is when they use the enswell as a weapon! There have been times when I have seen more damage inflicted by this simple tool than by the opponents’ fists. Firm direct pressure does not mean trying to push the swelling away from the affected area. If there is swelling around an eye, you cannot make it disappear by using extreme force to try and rub it away from the eye. Remember, the swelling comes from cell fluid leaking into the damaged tissue. If you force it away by hard rubbing, you are simply damaging more tissue - and will ultimately cause more swelling. This could work for a round or two, but ultimately the swelling will increase if you use the enswell as nothing more than a rolling pin. Think about it!

G) Vaseline.

Obviously makes the skin slippery and less likely to tear.

Other agents can be incorporated into the Vaseline.

Never use gobs of Vaseline...will just end up on gloves and hence in eyes.

H) Adrenaline (epinephrine).

Used in a concentration of 1:1000.

Safe when used topically.

Natural chemical that will be absorbed in the open skin and decrease blood flow.

(Newer Agents)

I) Avitene.

Microfibullar Collagen Hemostat.

In contact with bleeding surface, will cause platelets to adhere and form quick clot.

J) Thrombin.

Protein that forms clot with fibrinogen.

K) Surgicel, Gelfoam, etc.

L) Monsels solution.

This is a lead based homeostatic that will work by destroying the surrounding tissues. It is or should be illegal in all locales. Can be spotted by the black ring of dead flesh around the cut.

I have seen these agents used interchangeably by cut men. They have heard of these cool drugs, and want to use them. They are NOT interchangeable! For example, Avitene can only be used if cut is actively bleeding, and Thrombin can only be used if blood is removed first and surface is dry!

One last pet peeve... a Q tip has a soft cotton end and should always be used gently. It is useful to help apply medicine to a specific area. The key word is “gently”. Why wield it as an instrument of terror in the corner. I have seen a large Q tip stuck forcefully up a bleeding nose. Think about this! The inside of your nose is super sensitive, and quite delicate. The correct way is to gently apply the medicine just inside the nostril and then apply pressure over the outside of the nose. 98% of all nasal bleeding is not deep within the nose, but actually very near the opening. Most of the significant blood vessels that bleed in the nose are not located deep within that poor orifice that has already been taking a lot of punishment from the opponents fists. Stop Sticking that Q tip in so Deep!

In closing...the cut man is an invaluable member of the team at ringside. The majority attempt to do all they can to help their fighters. I continue to learn from them. My basic tenet is to “ do no harm “.

Flip Homansky MD.

Also see Cuts..to stop or not? - Part I By Margaret Goodman

Part III of our series on cuts will come soon featuring a veteran cut man and his point of view.

***

Dr. Flip Homansky is the current Vice-Chairman of the Nevada State Athletic Commission (NSAC). For over twenty years, he served as Chairman of the Medical Advisory Board and Chief Ringside Physician for the NSAC.

Dr. Flip Homansky practices in Las Vegas, Nevada, where he had been a licensed ringside physician and Chairman of the Medical Advisory Board for the Nevada State Athletic Commission for over twenty years. His medical specialty is in the field of Emergency Medicine. Dr. Homansky was appointed by Nevada’s Governor, Kenny C. Guinn, in 2000, to serve as a Commissioner of the Nevada State Athletic Commission. Although he is currently Vice-Chairman of the Nevada State Athletic Commission, all of the views, opinions, and/or recommendations contained herein are solely his own and do not necessary 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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