Dr. Margaret Goodman

Medical expert: Dealing with cuts

Twenty-three stitches to close a cut above Robert Guerrero’s eye should have dispelled debate regarding referee Jon Schorle’s second-round stoppage of the Guerrro-Daud Yordan fight on March 7 in San Jose, Calif. But the discussion continues.

After clearance by the ring physician, Guerrero told Schorle he could not see because of blood in his eye and the fight was ruled a no-decision.

For those who wonder about that outcome and other fights that ended because of a cut – including the hotly debated Marco Antonio Barrera-Amir Khan matchup on March 14, which led to a protest by promoter Don King – let’s explore the issue.

A fight is stopped on a cut by the referee or on recommendation of the physician if: the fighter is unable to protect himself; allowing the fight to continue might result in irreparable damage; or the boxer is already losing or otherwise injured and the cut becomes the excuse.

Location often determines the outcome.

• Scalp lacerations – such as Vitali Klitschko’s last Saturday – are seldom serious, but the highly vascular scalp bleeds heavily and is tough to stop.

• Cuts inside the eye orbit can limit movement of the eyeball by affecting nerves and muscles or damage the tear duct.

• If on the actual lid, the fight must be stopped immediately as additional punches can damage the eyeball.

• Lip lacerations affecting the colored part of the lip (vermillion border) should result in a stoppage as they are tough to repair, produce scarring that might limit closure of the mouth.

• A “pumper” (arterial bleeding) in a fight must be stopped or it will produce serious blood loss and will only stop with stitches and lengthy direct pressure.

“I rely on the doctor,” says respected referee Steve Smoger. “If I see a cut annoying the fighter and there is blood – it looks pretty bad – I’ll call the doctor. Sometimes I may think it doesn’t look bad, but it is. I pay attention to the cutman. I may let it go longer if I trust them.”

Schorle stopped the Guerrero-Yordan bout once Guerrero said his vision was impaired. Typically, when a fighter tells the referee or doctor that he can’t see – game over. There are limitations to what a doctor can determine in the one minute between rounds or during a timeout, however. Blurred vision can result from something as harmless as blood in the eye but also from a retinal detachment. The official must err on the side of caution.

Sometimes the participants take advantage of a cut.

Boxing aficionados recall the 2001 Coney Island fiasco between Hector Camacho Jr. and Jesse James Leija, refereed by Smoger. The fight was stopped when Camacho Jr. declared he couldn’t see after the fifth round because of a cut caused by a clash of heads.

Smoger called in New York ring physician Robert Polafsky to examine Camacho. After a lengthy discussion with the boxer, Polafsky told Smoger the fight could continue despite the boxer’s complaint of blurred vision. However, Camacho’s promoter, Dan Goossen, waved for the fighter to stay in his corner to make it clear that he had no intention of fighting on, which would give him a technical victory on points.

By a twist of fate, it was determined that the bell to begin round six rang prematurely – while the doctor was examing Camacho – and the victory was changed to a no-contest. Five rounds must be completed to have a fight register on the books as a win or a loss in New York.

The participants aren't the only ones who manipulate the rules.

On March 14, Barrera suffered a horrendous cut on his scalp when he clashed heads with Khan and it bled profusely from the first round until the fight was called after the fifth round.

Why wasn’t the fight stopped sooner? Of, if not sooner, why after the fifth round?

The officials’ role is to enable a fight to proceed to its natural conclusion. In the Barrera-Kahn fight, the rules were manipulated or even abused to give Khan his victory. British officials should be ashamed of the way this was handled.

If a cut is bleeding but not in a dangerous location, it is fair to give the cut man a round or two to do his job. But if it can’t be stopped and the blood continues to interfere with the fighter’s ability to see punches coming or generally defend himself – as was obviously the case in this situation – the fight must be stopped.

The ring doctor looked at the cut after the first round, according to his cut man, Tony Rivera. Then, between the fourth and fifth rounds, the doctor mounted the ring apron again. I would have hoped this was to reassess Barrera. Instead, the physician never stepped into the ring to look at Barrera and actually stood on the opposite side of the cut. The cameraman could have made a better medical assessment.

No one knows whether Barrera would have performed better if he hadn’t been cut. His fate was sealed after the head butt.

But the continuous pumping of blood, the length of the cut (three inches, according to Barrera’s cut man) and its depth (possibly through muscle and down to the bone) dictated that the fight should have been called immediately.

Controversy also arises when doctors or referees don’t sell their call to the audience, commentators and members of the media. Few officials understand this better than Smoger.

“John (Schorle) did everything a sharp referee should do,” said Smoger. “Guerrero’s cut warranted the stop.”

This was difficult to understand until Guerrero’s manager released photos of the surgical repair a few days later.

During the bout, either the doctor was unsure about the severity of the cut or there should’ve been better communication between the referee and physician to make the correct call at the right time. This put Schorle in a difficult spot. He obviously knew it was time to halt the fight, but it appeared awkward because he lacked help from the ring physician.

In the Barrera bout, the referee and physician ignoring the cut until the fight could go to the books as a victory for Khan created a sense of impropriety.

If the referee and ring physician wanted to allow the fight to continue fairly, they should’ve come up with a plan of action away from the microphones to demonstrate they were on top of the situation.

Other than absorbing more right hands, Barrera didn’t look much worse in the fifth round than he did in the first round. If the cut had worsened, which could be the only justification for waiting until after the fifth round to stop the fight, neither the referee nor the doctor demonstrated that.

Ringside Medicine 101 teaches the doctor that when working a televised fight in which a fighter is cut, you get in there and demonstrate you are either concerned or not. In the former case, you periodically check the cut and spread it open for the camera until you hear the gasps of the fans. In the latter case, everyone, especially the fighters, can concentrate on the job at hand.

More explicit behavior by the referees and doctors in both fights would have eliminated any additional speculation regarding their actions and would keep attention on the fighters, where it belongs.

Dr. Margaret Goodman is a practicing neurologist in Las Vegas. She is a former Medical Advisory Board Chairman and Chief Ringside Physician for the Nevada State Athletic Commission

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