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Boxing Injuries:  La<: erations

An in depth look at the lacerations that
occur over the duration of a boxing match

f

I’...
The head and the face are targets in boxing.  It
is intuitive that injuries to this region of the
body may occur during a ...
épecifically lacerations to the eye
region account tor 49.8% ot all
injuries.  Facial Lacerations are
the prlvviary reason ...
Before vv-e discuss the
e, vct; lu. ct. ti, o n.  of‘ 1.ctcerct. t;io n_s
by (I:  rings ide phy-si. ci, ct. n. it
is it is...
A punch to the face is a bursting type of
injury.  In other words the tissue is
compressed against the bony ridges of
the ...
Examples include the
eyebrow and cheek bone
region immediately under the
eye.  This is known as the peri-
orbital region (...
The face and scalp are very vascular
regions therefore small cuts can bleed
quite profusely.  The scalp in particular is
c...
RINGSIDE
EVALUATION OF
FACIAL LACERATIONS

The ringside physician must decide when the
laceration is too severe for the fig...
The first eonsitlel-ation is location
of the laceration.  If a laceration is
in an EII‘t= .'EI that impairs vision the
fig...
The obilitg to onticipote 0 blow to the hood
ollows 0 boxer to better defend himself ond
thus is o primorg foctor in ovoid...
Also there are structures on the face primarily arteries

and nerves which can be exposed by a laceration and if

injured ...
The ringside physician must
decide when the laceration is too
severe for the fight to continue. 
This can be a complicated...
The first consideration is location of the laceration.  If
a laceration is in an area that impairs vision the fight
needs ...
A second consideration is the
length and depth of a laceration. 
Keep in mind that lacerations in
combative sports occur f...
Deep lacerations can
involve muscle and
other structures and
are a more serious
injury.  Lastly excessive
hleecling may wa...
REPAIR OF FACIAL
LACERATIONS

lls stated before the facial region is very
vascular and subsequently facial
lacerations wil...
Sutures (stitches) are placed in the deeper tissues
to bring those structures closer together.  This
material will dissolv...
Figure 5: Repaired facial laceration from figure 9. Note that this wound
required placement of several sutures in multiple...
A final word about lacerations.  Often when a fighter is
cut and bleeding those in attendance will cry out ”he
has been cu...
A Big 'll‘IrainIr You To
Dr.  Don Monti
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Boxing Injuries: Lacerations

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Ringside physician and medical professional, Dr. Don Muzzi, and boxing coach Chuck Horton examine the lacerations that occur in boxing in this in depth and informative presentation.

Published in: Health & Medicine
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Boxing Injuries: Lacerations

  1. 1. Boxing Injuries: La<: erations An in depth look at the lacerations that occur over the duration of a boxing match f I’ By Chuck Horton & Dr. Don Muzzi
  2. 2. The head and the face are targets in boxing. It is intuitive that injuries to this region of the body may occur during a bout. The most common sites injured in boxing are the head, neck, face, and hands. Bledsoe et al. reported facial lacerations accounted for 51% of all injuries. The British Journal of Sports Medicine in 2003 reported that the head, neck and face are the most commonly injured areas on a boxer, comprising 89.8% of injuries, with 75% being facial lacerations.
  3. 3. épecifically lacerations to the eye region account tor 49.8% ot all injuries. Facial Lacerations are the prlvviary reason a ringside physician stops a tight. it is ivviperalive that ringside physicians, reterees, otticials and corner ivien have a understanding regarding tacial lacerations.
  4. 4. Before vv-e discuss the e, vct; lu. ct. ti, o n. of‘ 1.ctcerct. t;io n_s by (I: rings ide phy-si. ci, ct. n. it is it is irn. portct; n,t: to u_n_d_erst; Ot. n_d. sorne of the f'u. n.d. ct: m.e n. t;ct.1. rne c h. ct: ni_s regor; rd. i,n. g' this type of inj ury. A. tjyp ic ct; 1. l_<1.cer-cttion. t: h.ct_t: is cctused. by CI. ‘ shctrp object (1e. g. ct; k: n.if’e or piece of'g1.cr. -ss) is CII1. out-si, d.e in. su,1.t: t; h,ct. t: ex; ten. d_s into the deeper t. -issues frorn. the sk: in. .
  5. 5. A punch to the face is a bursting type of injury. In other words the tissue is compressed against the bony ridges of the facial skeleton and the tissue is cut from the inside out. Therefore, the external cut as seen on the skin represents only the "tip of the iceberg". The cut is actually larger in thedeeper tissues. Some regions of the facial skeleton have a rougher surface under the skin and they are more prone to lacerations.
  6. 6. Examples include the eyebrow and cheek bone region immediately under the eye. This is known as the peri- orbital region (see figure 1). Fig 1: Klitschko vs Lewis 2003
  7. 7. The face and scalp are very vascular regions therefore small cuts can bleed quite profusely. The scalp in particular is composed of rigid connective tissue that does not allow blood vessels to collapse and bleeding can appear rather dramatic. It is important that the ringside physician and the referee do not panic when a cut appears to aggressively bleed. The good news is that the extensive vascular supply allows facial and scalp lacerations to heal quickly and makes them less prone to infection after they are properly repaired.
  8. 8. RINGSIDE EVALUATION OF FACIAL LACERATIONS The ringside physician must decide when the laceration is too severe for the fight to continue. This can be a complicated decision that is based on medical knowledge and experience, however there are some fundamental considerations.
  9. 9. The first eonsitlel-ation is location of the laceration. If a laceration is in an EII‘t= .'EI that impairs vision the fight needs to be stopped [fig 2]. Inability to see I‘l! IItII2l‘S a fighter more susceptible to brain injury. Fig. 2 Laceration resulting in impaired vision
  10. 10. The obilitg to onticipote 0 blow to the hood ollows 0 boxer to better defend himself ond thus is o primorg foctor in ovoiding 0 concussion or other brain injurg. Locerotions on the egelid mog domoge on oreo known os the torsol plote. lnjurg to the torsol plote mog result in o defective blinking mechanism which con couse longterm domoge to o fighters vision. If the torsol plote is injured or ot on increased risk of being injured 0 fight must be stopped.
  11. 11. Also there are structures on the face primarily arteries and nerves which can be exposed by a laceration and if injured could cause significant or permanent damage. Lacerations to the corner of the eye may damage 3 Injuries Around the Eyes: structure known as the ' "‘ lacrimal duct and impair the tearing mechanism (figure 3). Lacerations that involve the lip and progress onto the skin (this area is known as the vermfllion border) may result in a --~--«-—-------- Significant tear and require Figure 3: Location of Tarsal Plate and S1.-1Oppa’ge_ nasolacrimal duct. Lacerations in these areas may require stoppage of fight
  12. 12. The ringside physician must decide when the laceration is too severe for the fight to continue. This can be a complicated decision that is based on medical knowledge and experience, however there are some fundamental considerations.
  13. 13. The first consideration is location of the laceration. If a laceration is in an area that impairs vision the fight needs to be stopped (fig 2). Inability to see renders a fighter more susceptible to brain injury. The ability to anticipate a blow to the head allows a boxer to better defend himself and thus is a primary factor in avoiding a concussion or other brain injury. Lacerations on the eyelid may damage an area known as the tarsal plate. Injury to the tarsal plate may result in a defective blinking mechanism which can cause longterm damage to a fighters vision. If the tarsal plate is injured or at an increased risk of being injured a fight must be stopped.
  14. 14. A second consideration is the length and depth of a laceration. Keep in mind that lacerations in combative sports occur from the inside out. Therefore, the laceration is generally much larger than than the exposed cut on the surface of the skin.
  15. 15. Deep lacerations can involve muscle and other structures and are a more serious injury. Lastly excessive hleecling may warrant a medical stoppage Figure 4). Figure 4: Facial laceration demonstrating multiple reasons to stop the fight. Note length and depth. vision impairment, and exposure of underlying nerves and arteries. This injury also demonstrates that lacerations are larger in the deep tissues below the skin layer. The bleeding was controlled at this point point but at the time of injury bleeding was excessive and vision was impaired by the bleeding.
  16. 16. REPAIR OF FACIAL LACERATIONS lls stated before the facial region is very vascular and subsequently facial lacerations will heal quickly after repair. Remember that the lacerations occur from the inside out and are generally deeper on the inside i. e. the deeper tissues. The ringside physician therefore needs to repair the injuries from the inside out.
  17. 17. Sutures (stitches) are placed in the deeper tissues to bring those structures closer together. This material will dissolve over time and does not need to be removed. After the deeper layers are closed sutures are placed in the skin. These sutures are generally removed in five days. Facial lacerations usually require a 45 day suspension. More severe cuts may require a longer suspension. At 45 days the tissue has reached about 75% of the strength of the original tissue. In approximately 6 months to 1 year the healed wound will be about 90% as strong as the original tissue. Even the best repaired cut is never as strong as the original tissue and therefore. is susceptible to repeat injury and a second laceration.
  18. 18. Figure 5: Repaired facial laceration from figure 9. Note that this wound required placement of several sutures in multiple tissue layers below the visible skin sutures.
  19. 19. A final word about lacerations. Often when a fighter is cut and bleeding those in attendance will cry out ”he has been cut”. Lacerations are very visible and get the crowds attention. I-lowever, after the fight the laceration will be repaired and heal with little long term consequence to the boxer. The ringside physician, referee, and other officials must be sensitive to the fact that repeated blows to the head pose the real long term health threat to the boxer. One needs to respect lacerations and if necessary stop the bout. I-lowever, it is brain injury that may cause irreparable damage to the athlete.
  20. 20. A Big 'll‘IrainIr You To Dr. Don Monti

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