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True blood

With all this fighting, how do you stop all that bleeding?

Originally Published: September 16, 2013
By Chris Jones | ESPN The Magazine

Jones IlloMark Matcho for ESPNThe secrets of top cut men include seaweed, shrimp and Australian cows.

This story appears in ESPN The Magazine's Sept. 16 Fighting Issue. Subscribe today!

JOE SOUZA, the late and legendary cut man, used to sit at his kitchen table and slice open his left arm, oblivious to the pain and howls of protest from his wife, Virginia. By the time he died in 2011, he had dozens of thin scars on his skin. "They weren't around veins," he once told me. "I wasn't a wacko." Souza was just particularly dedicated to his craft. Even after he'd spent decades rescuing some of the sport's all-time bleeders, from Arturo Gatti to Wladimir Klitschko, he continued his lifelong search for cures. Souza's kitchen was his laboratory; he was his own rat.

His preferred fix wasn't exactly legal. Virginia's ophthalmologist tipped off Souza to Surgicel, a hemostatic gauze used to control bleeding during operations. Back then, medicated gauzes hadn't been approved for use by boxing's governing bodies, but Souza would roll Surgicel into tiny bundles, which he hid in the crook of his elbow. He would jam the gauze into a cut and then glue it into place with a smear of Vaseline spiked with aloe, grown in his own garden. It formed a literal plug. "You learn from experience," Souza said. "You have to go out into this world."

The fight game has since caught up with Souza and his secrets: Gauzes are becoming increasingly popular -- and permitted -- in boxing and MMA. "It's a game changer," says 61-year-old Jacob "Stitch" Duran, today's most celebrated cut man thanks to his frequent appearances in UFC's blood-soaked octagons. He remembers the first time he found an unexpected salve: He cut his finger as a child while chopping cotton in California, and his mother wrapped the wound with cobwebs, an ancient remedy. The experience made him receptive to ideas both old and new.

Before 2009, cut men had only three sanctioned means to curb bleeding, other than pressure: adrenaline chloride, thrombin and Avitene. Adrenaline and thrombin are naturally occurring chemicals, usually applied with cotton swabs. The first shocks blood vessels into constricting; the second is one of the principal agents of the "clotting cascade," a pretty-sounding term for the scabbing process. But Avitene, developed during the Vietnam War, has long served as the cut man's most miraculous cork.

A company called Davol produces several versions of Avitene. Most cut men use the powdered form, which looks like flour and is made exclusively from the tissue and hides of Australian cows because they're isolated from the ravages of mad cow disease. Like our own skin, cowhide contains collagen, a protein that attracts platelets, blood's built-in coagulant. Avitene acts as a kind of magnet, drawing more platelets than might otherwise find the hole in a fighter's forehead, allowing clots to form in that single frantic minute between rounds. Duran famously packed it into Forrest Griffin's wide-open face during his fight against Shogun Rua in 2007, allowing Griffin to last long enough for the surprise win.

Nature has since yielded several other ways to lure platelets to cuts, and various manufacturers have put them into gauzes that also absorb plasma, drying the wound, a double benefit. Duran now endorses one called Qwick-Aid, which includes seaweed harvested off New Zealand and elsewhere in its mostly secret formula. He first employed a square of Qwick-Aid on Klitschko, Souza's former client. Unlike Souza, Duran doesn't leave the gauze in the cut.

"It's the new medical wonder," says Duran, who hasn't used Avitene since. "It might even take away the need for a good cut man." Other hemostatic gauzes are also finding their way into corners. The Nevada State Athletic Commission now allows Celox, made from purified shrimp chitin, extracted from shrimp shells, and recently approved QuikClot, which contains kaolin, a mineral found in cosmetics for centuries.

"Platelets have to collect on something," says Dr. Timothy Trainor, the commission's consulting physician since 2007. "All these products act as a kind of scaffolding." Trainor served as a combat surgeon in Iraq, where he became all too expert in extreme blood loss. Now, as with Avitene, the lessons learned on our real battlegrounds have been passed on to our canvas ones. They are the same lessons learned in Joe Souza's kitchen and in Stitch Duran's cotton fields: For all the ways the world might hurt us, it's given us as many ways to stop the bleeding.

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Chris Jones is a feature writer for ESPN The Magazine. He is also a Writer at Large for Esquire.

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