Boxing Injuries: La<: erations
An in depth look at the lacerations that
occur over the duration of a boxing match
I’ By Chuck Horton
& Dr. Don Muzzi
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.
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.
Before vv-e discuss the
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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
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
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.
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
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
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.
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
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
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.
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.
Deep lacerations can
involve muscle and
other structures and
are a more serious
injury. Lastly excessive
hleecling may warrant a
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.
REPAIR OF FACIAL
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.
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
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.
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.