Thursday, October 9, 2008

Doctor Who Operated On Nick Diaz Explains Procedure MMANEWS.COM

Dr. Frank Stile, who performed the surgery on Nick Diaz to help prevent cutting during his fights sent along the following breakdown of the procedure:



Let Them Fight



I first met Nick Diaz as a guest in my home. He and mutual friend were there to watch a televised UFC event. This was shortly after his [Nick’s] bout against K.J. Noons. Nick was obviously disgusted with the outcome, and unlike his TV persona had very few words on the matter. The fight was stopped due to the severity of the lacerations that Diaz sustained over his eyes during that fight. This was not the first time that this problem (cutting) has plagued Nick or other fighters.

Having seen the fight, I offered Nick a possible solution to his problem. A solution that would give him the best opportunity to finish fights without stoppage from cuts. He seemed very interested…this got his attention! I explained that as a reconstructive plastic surgeon, I have solid experience in treating facial trauma and complex wounds. Being an avid boxing and MMA fan, I had conceptualized a technique from several reconstructive facial that could be adapted for this purpose.

I began by explaining why I believed this was happening to him and other fighters. The mechanism is simple, the superior orbital rim, or bony ridge above the eye socket, acts as a sharp edge.(Figure 1A) A blow to the eye, usually straight punch or upper- cut, generates tremendous force against the skin over this bony ridge. The result is what is often referred to as a “blast type” laceration or cut. This occurs when these forces exceed the bursting-strength of the skin.



Every fighter’s skull is unique, and as a result, some fighters seem to be more prone to this type of injury than others. Nick Diaz is one of these fighters. What makes matters worse is the inadequate care that many of these fighters receive as treatment of these cuts. Skin is a multi-layered structure that should be closed (stitched) in several separate layers when injured. Most on-site fight doctors or emergency room physicians will close facial lacerations in one simple layer with a nylon suture that is then removed in 7-10 days.

(Figure 1A)

Single layer closure does not adequately address the dermis which is the deeper strength layer of the skin. The result is what is referred to as an unstable scar. These scars spread, appear wide and are often discolored. This skin is attenuated or thin.



Additionally, many fighters do not allow their injures sufficient time to heal following repair prior to sparring or actually fighting without head-gear. Often re-injuring the same wounds. This results in a vicious circle of injury and re-injury without true healing ever occurring.



The normal skin healing sequence is as follows:

• At 2 weeks the wound has achieved about 20% of its pre-wound strength.

• By 5 weeks it is at about 50%.

• By 10 weeks it is at about 80% of pre-wound strength.

• Remodeling and maturation of the scar will continue for a year or more.

I believe a minimum of three months (90 days) is required for properly treated cuts to heal prior to subsequent unprotected fights. With all this explained to Diaz, he was anxious to proceed. After the appropriate pre-operative work-up, preparation and consent I scheduled Nick for surgery.

The Procedure went as follows:

1. Under general anesthesia, I excised all unstable scar back to a healthy skin edge.

2. The orbit’s bony ridge is then exposed. 3. A burr or chisel is used to dull the sharp edge of the orbit’s bony ridge. 4. A 1.0 x1.0 centimeter dermis pledget (from processed donor tissue) placed over this bony edge (photo 7) and sutured into place. This pledget is made of Neoform Dermis by the Mentor corporation synthesized from purified human collagen. 5. The skin was then closed in layers over this tissue implant. 6. Pre operative and postoperative images.

Over the next several weeks the surrounding skin incorporates (grows into) this dermis implant. The implant is eventually totally absorbed and is replaced by Nick’s own skin.

Nick has thus far had two professional fights (Japan & Hawaii) since his surgery in addition to countless full-contact training/sparring sessions. He has been on the receiving end of numerous direct kicks and punches to his brow with nothing more than a 1.0 centimeter partial thickness wound (a scratch) to his left upper eye success!



For athlete considering this procedure your choice of doctor is critical. Only surgeons comfortable with facial anatomy and who have significant craniofacial and reconstructive surgery experience should attempt this type of surgery. There are risks associated with it including but not limited to infection and nerve injury.



In concluding, this is the first report of this procedure performed for this purpose. It has for the moment proved to be of value. I believe that tissue augmentation and/or restoration is the only ---method of giving fighters a chance to continue on in their careers without being limited by severe cuts.