Doc says Manny's cut down to bone

MANILA, Philippines - Cosmetic surgeon Dr. Jeffrey Roth said yesterday WBO welterweight champion Manny Pacquiao’s cut that he suffered in his recent fight against Juan Manuel Marquez in Las Vegas was deep, down to the bone, and had to be sewed up in multiple layers.

Dr. Roth attended to Pacquiao in the dressing room after the bout in the presence of the fighter’s wife Jinkee, cutman Miguel Diaz and Dr. Vicki Belo, among only a few others. He used 28 stitches to patch up the wound – eight in the inner, eight in the middle and 12 in the outer layer of skin. The procedure took about 30 minutes.

“Manny had a laceration over the superior orbital rim, the facial bone,” said Dr. Roth in an e-mail to The STAR. “It was on the forehead with extension into the eyebrow. It was deep, down to the bone, and therefore had to be stitched up in multiple layers. We usually try and close the wound in multiple layers so as to take the tension of the outermost layer, the skin. This construct makes the scar stronger. However, there is no guarantee that it won’t open again if hit with great force. Scar tissue is never as strong as unharmed tissue.”

Dr. Roth, 45, primarily works with fighters promoted by Top Rank. He was previously called on to treat Pacquiao in the second Marquez fight and the battle against Miguel Cotto. “Manny had two wounds in the Marquez rematch, one on his eyebrow and the other on his eyelid,” noted Dr. Roth, a Brandeis University and University of Nevada School of Medicine graduate. “In the Cotto fight, Manny had to have his ear drained so as to avoid having a cauliflower ear.”

Describing Pacquiao’s cut from the recent Marquez bout, Dr. Roth said it was jagged in spots and a deep laceration. “Each wound is different,” he explained. “This is a common place, on the brow over the eye, for boxing wounds. This was similar to a wound that Zab Judah had. I believe multiple sources have said it (was caused) by a headbutt. This type of wound could be caused by a headbutt or a punch.”

According to Pacquiao’s trainer Freddie Roach, the cut was inflicted by an accidental headbutt in the 10th round.

Dr. Roth said Diaz did a good job of stopping the bleeding in the corner. “Miguel is arguably the best in the business,” he continued. “He stopped the bleeding. When Manny got back to the dressing room, we washed out the wound and removed any debris before closing it.”

As for Pacquiao’s cut lip, Dr. Roth said it was no problem. “He sustained a cut on his lower lip,” said Dr. Roth. “In the dressing room, it wasn’t bleeding. We decided not to formally suture it up at that time. We checked it the next day and Manny thought it was okay and did not need sutures.”

During a bout, the cutman in the corner takes care of controlling the flow of blood from a fighter’s gash whether opened illegally or not. “The cutman’s job is to stop the bleeding so that the fighter may continue,” said Dr. Roth. “He only has a minute between rounds to get this done. They use many methods – pressure, cold – and substances like vaseline, adrenaline, avitene, thrombin, surgicel. Often before a fight starts, vaseline will be applied to the fighter in the hope of the punches ‘sliding’ off the face.”

Dr. Roth said the degree of severity in a facial wound compared to a scalp cut depends on multiple factors. “How deep is the wound?” he asked. “Where is the wound? One has to look at the surrounding anatomical structures – bone, nerve, artery – and make sure they are not damaged or in need of repair.”

A Las Vegas resident since 1977, Dr. Roth has practiced medicine for nearly 20 years. He is certified by the American Board of Surgery, the American Board of Plastic Surgery and the National Board of Medical Examiners. Dr. Roth has been practicing in Las Vegas for about 10 years and treats all types of patients. He enjoys treating fighters as their plastic surgeon.

“It truly has been a dream come true to combine my passion for boxing with my professional experience as a plastic surgeon,” he said. “I have been fortunate with every opportunity I have had as the fighters I have worked on have all been true champions. Manny and Marquez are excellent examples of real champions who have achieved the peak of fitness and both mental and physical preparation. Manny’s boxing skills continue to progress. His power continues to increase as he ascends in weight class. Going up in weight has clearly not impacted his signature speed.”