19 Dec MMA Fighters and Recurrent Facial Injury
Nate Diaz is a professional mixed-martial arts fighter from Stockton, California. He recently had a very high-profile fight against an accomplished opponent named José Masvidal. Despite a respectable performance by Diaz, the fight was ultimately called off by a ringside physician due to a cut above Diaz’s right eyebrow. The wound was bleeding significantly and felt to be compromising Diaz’s ability to see and safely continue the fight.
As a surgeon, and very inexperienced observer, the most interesting part of this fight to me was learning that Diaz had previously injured the exact same part of his face numerous times in the past. As we know from wound care science, skin that has healed from previous injury is never as strong as uninjured skin. With each progressive injury to the same spot, the tensile strength of our scarred skin becomes weaker and weaker. In the case of Nate Diaz, his previous injuries to the right brow have left this region very susceptible to re-opening, especially so as there is minimal soft tissue “padding” between the skin and underlying bone to help absorb the blow in this part of the face.
For a professional fighter, this is an obvious liability. Opponents can, and do, target Diaz’s right eyebrow region knowing that it is particularly vulnerable to injury and bleeding.
What options do fighters have in situations like this? Besides not fighting at all and/or being very mindful of their body’s “weak spots” during fights, my best advice is to wait long periods between fights to allow the healing process to complete its course. The healing process for some complex lacerations can take well over a year in some cases to reach a steady state. Make sure that a surgeon has evaluated your wound, and that the wound was appropriately sutured closed (which may need to be done in layers). One would hope, given the stakes involved, that the suturing being done in locker rooms is being performed by surgeons with a lot of experience in facial wound closure!
Finally, in cases of recurrent injury to the same location numerous times, I would consider the surgical removal of the recurrently injured/weak tissue and replacement by a new, stronger, surgical scar. Surgical scar removal is routinely done for cosmetic reasons, but in this case also effectively trades very weak/damaged scar tissue for stronger scar tissue. This solution does not offer the tensile strength of previously uninjured skin but should, at the very least, result in a stronger scar than the one it replaced. Additionally, during the healing period I would recommend temporarily paralyzing the facial muscles surrounding the injured site with botulinum toxin (Botox, etc). This effectively acts as a cast and immobilizes the wound to allow for optimal healing.
Best of luck to all the athletes out there, and stay safe!