The person responsible for preventing and treating injuries to a fighter is referred to as a cutman, his job is crucial to a fighter’s success in the ring. His art is performed primarily in the corner during the one minute rest interval (recovery period) in between rounds of a professional bout; such as Boxing, Muay Thai, and Mixed Martial Arts.
The responsibilities of cutmen most often include attending to swelling in all areas of the head, nosebleeds, and lacerations; which we’ll refer to as cuts. This medical intervention is vital because if any of these injuries remain unmanaged they can lead to the referee stopping the match prematurely , consequently resulting in a loss to the injured fighter and further exposing him to serious unnecessary physical injury. It’s evident why a professionally qualified and experienced cutman plays a pivotal role on a fighter’s team and can be a decisive factor not only in the outcome of the match, but also in the fighter’s long-term health and well being.
Generally, cutmen are not physicians or fight doctors, though in the United States the various athletic commissions require licensure in order to work in a fighter’s corner. Because of the lack of uniformity that exists among all boxing commissions, the allowed medications to treat cuts vary within each state. Generally speaking, there is no formal training or certification required to become a cutman, the art is learned through self-education, on-the-job training, and apprenticeship. The industry standard regarding compensation ranges from 1-5% (net) of a fighter's prize money.
Trauma Prevention / Hand Wrapping
Cutmen perform the meticulous art of wrapping/taping of a fighter’s hands in the presence of a state athletic commission official. Then, petroleum jelly is applied to common sites of impact, particularly the prominent boney areas of the fighter’s face that are prone to sustain injury. The intended purpose is to allow skin elasticity, pliability, and a slippery quality; making it less likely to absorb the full impact of a punch or kick, resulting in blunt force trauma which can potentially lead to cuts. An experienced cutman is aware to not apply too much petroleum jelly to an injury site; because excess amounts will only end up on the opponent’s gloves, and very likely in the fighter’s eyes.
Swelling is frequently associated with facial hematomas, any collection of blood outside of the vessels of the face. A facial hematoma, in the trade, is referred to as a “mouse.” Such an injury is traditionally minimized by applying firm direct pressure with a chilled enswell, a small metallic object with a handle, or ice bag directly on top of the trauma site.
Since time is of the essence in between rounds, and if the situation warrants it a competent cutman will be inside the ring before the fighter reaches his corner and will start treating the injury site immediately in order to maximize the one minute rest interval. A common and often costly mistake is to use the enswell to “iron-out” the swollen area. This is attempted by applying pressure upon the trauma site in an effort to disperse or move it to a safer area of the face, most often away from the eye. Not only is this doomed to fail, but it may disrupt the microscopic blood vessels under the skin; leading to an increase in bleeding and enlargement of the swollen area.
Most nosebleeds occur near the opening of the nose. To stop the bleeding, cutmen generally apply a cotton swab soaked in an adrenaline hydrochloride solution to the trauma site, while simultaneously pressing the nostril against the cotton swab with the other hand. Once the bleeding has stopped, the area is chilled with an enswell or ice pack to reduce swelling and contain the bleeding.
The swallowing and aspiration of blood may lead to nausea, vomiting, and life threatening consequences. To prevent this from occurring a cutman will instruct his fighter to breathe through his mouth during treatment. The bleeding is generally treated like a benign nosebleed; however, when a broken nose is suspected (typically detected by a heavy flow of dark colored blood) which typically presents a greater challenge, the cutman should always err on the side of caution by consulting with the ringside physician.
Cuts are the focus of cutmen, hence the name, because if bleeding isn’t stopped promptly the ringside physician has the authority to stop the fight and declare the fighter’s opponent the winner of the match. Incidentally, ringside physicians will stop a match if the fighter sustains a laceration that’s perpendicular to the eye.
It’s important to first understand a few words. Hemostasis is the cessation of bleeding by the physiological properties of vasoconstriction and coagulation, or surgery. Vasoconstriction is the constriction of a blood vessel by a nerve or drug. Coagulation is the process of the blood forming clots. With this in mind, let’s take a look at the medications cutmen use to treat cuts.
Adrenaline hydrochloride (a.k.a. adrenaline chloride, typically in a 1:1000 solution) Applied topically to reduce blood flow, adrenaline hydrochloride is arguably the most common medication used by cutmen. It’s interesting to note that in the United States, while the term adrenaline is commonly used, the medical community prefers to use the term epinephrine. The choice was made in response to a pharmaceutical company claiming a trademark for “adrenalin.” That said, adrenaline and epinephrine are typically used interchangably.
Avitene, A microfibrillar collagen product, Avitene works best when applied dry. However, if this isn’t possible, the following, or a similar technique, should be used.
The surface of the wound should first be compressed with dry gauze and then covered with Avitene. The amount required will depend on the force and severity of the bleeding. Moderate pressure now needs to be applied over the Avitene with dry gauze. The application of Avitene, in either the fibrous (flour) or non-woven web (sheet) form, directly upon the source of bleeding is paramount. Applied in any other manner, Avitene may seal over the exit site of a deeper hemorrhage and conceal an underlying hematoma.
The period of time necessary for maximum response varies with the severity of the bleeding, ranging from one minute for capillary bleeding to three to five minutes for brisk bleeding or arterial leaks.
After five to ten minutes, excess Avitene should be removed, either by teasing it away or irrigation with saline solution; followed by aspiration. If breakthrough bleeding occurs additional Avitene may be applied, the indicated amount determined by the severity of the bleeding. As a guide, one gram will normally treat an area of 50cm2. Thicker coverage may be required for brisk bleeding.
Thrombin (Recombinant) Topical Solution
Thrombin is a coagulation protein found in the blood stream that actually traps large numbers of blood cells, forming a dark red scab. It works best when blood is removed and the surface is dry.
Surgicel and Gelfoam
These agents are used less frequently for coagulation than Avitene and Thrombin. Surgicel is an oxidized cellulose polymer, and Gelfoam is a porous and pliable product made from purified pork.
Monsel's solution: This outlawed agent quickly stops blood flow by chemically cauterizing the tissues surrounding the cut and a side effect of its use is the generation of scar tissue. This scar tissue is hazardous to an active fighter’s health and safety in that there’s an increased risk of re-injuring the scar site when direct force from a punch is absorbed. The application of Monsel’s solution can be spotted by a dark ring of damaged tissue around the cut. Monsel's solution is an iron subsulfate solution and, contrary to popular misconception, contains no lead in its composition.
One final note on cut care...petroleum jelly should always be applied to cut site in order to seal the wound and to prevent further injury from occurring, immediately before a fighter begins the next round. An experienced professional cutman will use a homemade salve composed of petroleum jelly and adrenaline hydrochloride to ensure the wound continues to be treated during the course of a fight.
Written and researched by: Manny Masson