Cutman

A standard enswell used by cutmen to reduce swelling from facial injuries.

Swelling is usually associated with facial hematomas (bruises — localized bleeding outside of blood vessels), and is traditionally reduced by applying firm pressure with a chilled enswell or an ice bag on top of the area of trauma.[2] The cutman presses the enswell against a fighter's skin to cool and reduce swelling from injuries, especially in areas around the eyes where swelling can impair vision. Since the time between rounds is very short, cutmen try to apply the enswell right away and hold it as long as they can, but a common mistake is using the enswell to push directly on the swollen area in an attempt to disperse it or move it into a safer place such as away from the eye.[3] Such treatment will not move the hematoma, and may disrupt the microscopic blood vessels under the skin, thus causing an increase in bleeding and enlargement of the swelled area.

PFC Raelina Shinn (left) battles on with a nosebleed during the first female fight in the Armed Forces Boxing Championships.

Cuts (lacerations) are the primary focus of the cutman because unless the bleeding is stopped promptly, the fight physician may stop the fight and declare that the injured fighter has lost the match. Physicians also will stop a match for a laceration that is perpendicular to the eye. The most common area of the face to be cut is around the eye. Cuts are treated by applying a cold towel to clean and simultaneously cool the area of the cut, causing a decrease in blood flow. A cotton swab soaked in epinephrine is applied with pressure to decrease blood flow even more, and Avitene™ (an active absorbable collagen hemostat proven to accelerate clot formation) is put into the cut to coagulate the blood.[1] A cutman might also cover the area with petroleum jelly to prevent further damage.

Most nosebleeds occur near the opening of the nose. To stop the bleeding, cutmen generally apply a cotton swab soaked in epinephrine to the damaged area, while simultaneously pressing the nostril against the cotton swab with the other hand. Once the bleeding has stopped, the area is chilled with an ice pack or an enswell. The fighter is usually instructed to breathe through the mouth during the treatment.[2]

A broken nose is a more difficult case, and can be detected by a heavy flow of dark colored blood from the nose. The bleeding is generally treated the same way; however, the fighter is usually instructed to avoid swallowing blood as it may induce nausea or vomiting, and the cutman is more likely to consult the ringside physician to ensure the fighter's safety.

• Enswell, sometimes called end-swell, endswell, stop-swell, no-swell or eye iron, is a small piece of metal with a handle. It is traditionally kept on ice and is used to cool the area of a bruise or a cut by applying direct pressure to decrease the blood flow to the area.
• Cotton swabs are used to apply medications to the fighter's wounds. While some cutmen use ready-made cotton swabs, others make their own.[1] It has been suggested that the practice of past cutmen's in keeping cotton swabs behind their ears or in their mouths is unsanitary and unprofessional.[3]
• Ice packs are used to cool bruises, cuts and sprains, and to keep the enswell cold.
• Petroleum jelly is put on the cuts and most likely areas of impact to make the skin more elastic and slippery, and hence less likely to tear. Some cutmen cover cuts with homemade salve containing a mix of petroleum jelly and adrenaline chloride, so that adrenaline keeps getting applied to the wound during the bout. Also, perspiration from above the eyes will be prevented from reaching the eyes by applying petroleum jelly to the eyebrows.
• Gauze pads are used to dry cuts.
• Medical gloves are worn by the cutman to limit the fighter's exposure to infectious matter, as well as limiting the cutman's exposure to blood.

Cutmen used to create their own medications, and the recipes were passed from masters to apprentices as trade secrets. Today, the use of various medications in sports is highly controlled, and most cutmen use only two or three standard medications from the list below.

• Epinephrine (also adrenaline chloride, usually a 1:1000 solution): Applied topically to decrease blood flow. This is arguably the most common medication used by cutmen.[3]
• Avitene (microfibrillar collagen hemostat): Coagulant used for bleeding cuts. Usually used in a powder form. It works best when the surface is dry.[4] The treatment includes covering the affected area with Avitene, and applying moderate pressure with dry gauze.
• Thrombin: Coagulant used when the blood is removed and the surface is dry.
• Surgicel and Gelfoam: Two other substances also used for coagulation, although less frequently than Avitene or Thrombin.
• Monsel's solution: This widely outlawed hemostatic quickly stops the blood flow by chemically cauterizing the tissues surrounding the cut, while generating severe scar tissue. The application of a lead-based hemostatic can be recognized by the appearance of a dark ring of damaged tissue around the cut. However, Monsel's solution is an iron (sub)sulfate solution that contains no lead, contrary to popular misconception.[3]