Caring for Stitches In Thailand – Muay Thai Cuts, Aid, Healing, Training, Fighting, Scars
[Update: this is my June, 2017 article “How to Help Stitches Heal Faster”, which provides added information]
One of the things I know a lot about from person experience is being cut in a fight. I’ve fought 117 times in Thailand and my stitch count rides in at 84 stitches. I’ve had lots of cuts, lots of experience of getting stitches ringside, and all that follows – home care, training with stitches, removing stitches and the social consequences of cuts. So here’s my attempt to give a complete 101 on getting cut in fights and what to do with the stitches afterwards. I hope it helps and answers questions in advance.
This is perhaps a foundation post for a chapter in the book The Guide to Female Fighting in Thailand which I’m co-authoring with Emma Thomas, surely to be expanded there.
This will also be an updated page with information as I come to it, so if you have questions about stitches and cuts let me know on this companion Roundtable forum topic – or you can email me at sylvie AT 8limbs.Us
Different Areas of the face
Where your cut and stitches are located on your head make a huge difference in how they heal. If you have stitches up near your hairline, the skin is very thin and doesn’t move a lot with your facial expressions, so the stitches stay pretty immobile and heal up more quickly. If the cut is actually in the hair, like on the scalp, it can be a bit trickier because the hair must be shaved off to get the stitches and then it grows back just a little before you take them out, so if your sutures are with black thread and you have dark hair it can be a bit difficult. The stitches in my eyebrows look exactly like my actual eyebrow hairs, so picking out the stitches when it’s time to cut them out can be a bit difficult.
If your stitches are on a part of your face that has thicker skin or that moves, the healing takes longer. Eyebrows and cheeks are fleshy enough that the sutures can go in deep (which is good) but your everyday facial movements of talking, smiling, furrowing your brow against sunlight, etc. All that moves your face and that moves the skin where the sutures are. You’re not hurting yourself; it just takes longer.
Healing Time – What is Normal?
Generally speaking, stitches should stay in place for at least 5 days. Seven is a safe bet and 10 days is required for hard-to-heal situations. But you’ll know by looking at the cut. It should be closed all down the line of the cut with no gaps. There might be some “puckering,” where skin is kind of squished together like it’s caught in a zipper, but that’s normal for around the stitches. If the tissue around the stitches is still swollen, however, leave the stitches in.
The sutures will itch a little bit after a few days as the skin dries out. This is both normal and good. They’ll be a bit sore and achy the first day after you get them, way worse than when you first got them. But that’s okay as long as their not super red, oozing, or hot to the touch – all that can be infection. You want to keep the stitches covered for the first 24-48 hours. Don’t remove the dressing that the doctor gave you in this time if you can help it. If you have to shower, use a plastic cover over the dressing to keep them dry or only get your head wet in areas away from the cut. You want to keep that area dry and covered so it remains sanitary and allow for the blood to clot and form a seal against infection. This is a bit tricky because you got cut in a fight, so you’re covered in Vaseline and sweat. So naturally you want to shower and get all that gunk out of your hair, off your face, etc. Use a washcloth to wash around the dressing and don’t let the shower water drip/run from the top of your head onto the dressing – seriously, keep it dry for the first 48 hours.
After 24-48 hours you can take the bandage off and clean the would with rubbing alcohol and cotton balls. Dab, don’t rub. Don’t pull off scabs. Be super gentle and just get it clean enough that you can put some antibiotic ointment over the whole thing and get a new dressing on it. I used to leave my stitches exposed all the time, thinking that drying them out was the best bet. But with this latest set I’m seeing what a huge difference it makes to keep them moist (with the ointment) and covered with a bandage. Way faster healing and less scarring.
If you want to train while you still have the stitches in, do so carefully. Obviously avoid being hit on the stitches or any kind of pulling, grazing of the wound. You can cover the whole area with a thick blob of Vaseline to keep them moist and form a barrier against sweat, dirt, whatever else might get in there. Wash them immediately after training, dry them off well, and put your ointment and bandage back on. The doctor will tell you not to train, not to get them wet, not to sweat, etc. That’s all good advice; but it’s up to you. I always go back to training after 2 days and just use Vaseline, antibiotic ointment, a bandage and cleaning the stitches well after each session.
Even when the sutures come out, that area is going to be sensitive. So try not to get hit there or pull on that skin for a while even after you’re healed up. The rule in Thailand is 21 days from when you were cut to when you can fight again. It takes longer than 3 weeks for the tissue to be very strong again and, because of the difference in thickness between scar tissue and regular tissue, you’ll always be a little more prone to cut again on that spot, especially if it’s on the thicker areas like eyebrows, the thin skin near the eyes, or the cheeks.
an image from my post: Risking Your Beauty
How to Remove Stitches Yourself
You usually just end up removing the stitches yourself (or, a trusted trainer at the gym might if you are uncomfortable) – no, the image in the photo does not show stitches that are ready to come out . When they are ready, I use what is essentially a manicure set. Tweezers and some cuticle clippers. Boil your instruments for 1 minute, let them cool, then wipe them down with rubbing alcohol. Clean your sutures with rubbing alcohol and get in good lighting with a mirror. Use the tweezers to gently pull the knot of the suture away from your skin. Make sure you can see the thread on both sides of the knot clearly and then clip one side only, near the knot, and pull the opposite side to remove the stitch. Be very careful not to cut the knot off all together, as the thread will be lost in your skin and that shit sucks. It can get swollen and pus-filled for months. And it hurts.
Once you have all the stitches out, wipe the wound down with rubbing alcohol and then use a clean washcloth to make a hot-compress. Hold the hot towel on the cut for a few minutes to get blood circulating to the area. If there’s any fluid in there you can gently push it out through the holes left by the suture threads before they close up. Let the area dry off and cool down, put some antibacterial ointment on it and a bandage for one more day and then you can just start slicking the closed up, mostly healed area for training after that, no bandage.
How to Clean Your Stitches
Cleaning stitches is basically dabbing them with rubbing alcohol. You don’t want to rub and you don’t want to soak them in any way with water. Just make sure you get any debris that might be sticking to to the wound, gently brush off scabs as they’re ready to come off but don’t pull at anything. You should be able to see each individual stitch and its threads. If there’s a little redness, that’s okay, but you don’t want streaks of red or uneven swollen parts. I clean them 4 or 5 times a day. After any training, and then in the morning and evening. If you are not training, twice a day is fine.
Training With Stitches
This will depend on your coaches, your gym, your training partners, and your climate. Thailand is hot and lots of parts are humid, so keeping stitches dry – which is the older advice about sutures – isn’t possible even if you’re taking the whole week off. If you decide to train with stitches still in, wait at least 2 days after you received them to give the wound time to scab up and close. Keep the stitches covered when you train with antibiotic ointment and a bandage. Remove the bandage and clean the wound immediately after training so you’re not sitting in a damp bandage. If the stitches are somewhere that you can’t bandage, like in your hair/scalp (so nothing sticks, like a bandaid or whatever), then just put a heavy dollop of Vaseline over the entire length of the wound, covering all the stitches, to form a barrier. Then clean this immediately after training.
Obviously try to avoid being hit in your stitches or pulling on them at all. Some trainers will simply send you home. Some training partners lack the control to be able to work with them when you’re still healing. Just be cautious. You can spar with only kicks if you have a facial wound, so you don’t get punched in it. My trainer likes to make me wait until the stitches come out before he lets me clinch, but lately he’s been letting me clinch so long as the stitches are bandaged and tells me to stop if too much contact is being made. It’s you’re call, basically.
How Long Before You Can Fight?
The semi-official rule is three weeks before your trainer will let you fight again. I asked Pi Nu about this forever ago when I got my first real big set of stitches. He said that certainly you could fight before that time, but the risk of the cuts re-opening is 50/50 and it looks bad for your gym if they send you in before you’re healed up. It makes them look like they don’t know what they’re doing, basically. But that’s a saving face thing and you can fight as soon as your wound is closed and your stitches are out. If it’s an important fight that you don’t want to miss, go ahead and get in the ring once your stitches are out, but keep in mind that the risk of the cut reopening – depending on where it’s located – is reasonably high. I’ve had cuts reopen twice, and fought with cuts that could reopen probably a dozen times when they didn’t reopen.
Ring Side Doctors in Thailand
Ring Side doctors are pretty awesome. They get paid a flat rate for the whole night and stitch up anybody who needs it, straight out of the ring. I’ve only ever been offered anesthetic once, but a kid I trained with was astonished that I’d (at that time) never had anesthetic, so I guess it’s not as unusual as I thought it was… or depends on the size of the promotion. I don’t know. But the doctors are usually very good. They wear gloves, have antiseptic supplies and clean tools. You might be getting stitches laid out on a pool table for small stadia fights in Chiang Mai, or sitting in a plastic chair out in a field, being eaten by mosquitoes, if you are fighting a festival fight in Isaan or in outlying villages.
Only a few times have I had wonky stitches from ring doctors – once was a guy who was just simply inexperienced. I call him my “Doogie Howser” doctor because he was probably only 20 years old and didn’t have all the supplies he needed. The cut was in my hairline and he didn’t have anything with him to cut my hair, so he used a box cutter. I’m not kidding. Those stitches weren’t great and there weren’t enough of them. He gave me 3 stitches on a cut that should have required about 8; when Pi Nu saw it he tsk-ed and said he could have done a better job himself. But this case stands out because it’s very unusual. Twice now I’ve had stitches that didn’t actually connect both sides of the cut, which makes them pretty useless. But in both those cases it was when an existing cut had reopened, so I reckon it has something to do with that. Maybe the swelling is such that it’s hard to get the sutures in deep enough so they end up tearing out of one side and then you just have this single-side stitch. In any case, I don’t think the doctors messed up because they’re shitty doctors – ring doctors are generally very good. They might give you a single antibiotic capsule and a tylenol or something, but it’s mostly just stitching you up and a pat on the shoulder.
A note on displays of toughness
If you’re going to be fighting in a particular stadium or city frequently, it pays off to really buck up during the stitching process because this ringside doctor is the same doctor who may officiate your future fights – you see the same doctors frequently. He may be the one who decides if another fight of yours will continue. If you’re a long term fighter it is worth it to build a reputation for toughness with doctors over time. I know that I’ve been allowed to continue in several fights because the doctor knew I could handle myself from past experience – on the other hand an unknown ringside doctor once called a fight with a very tiny cut in my hairline (2 stitches), and little blood, probably because I was a woman.
This goes to some side advice especially for female fighters: When the doctor is examining your cut during the fight deciding if the fight should go on, it is imperative that you plead, plead, plead that you want to go on. As a female it might just be assumed that you don’t want to, especially if you remain passive as we sometimes do before doctors. I even now bounce up and down sometimes to emphasize my fight urge. Simple things in Thai to say to a ringside doctor are: “Wai, wai!” (I can endure!) “Dai, dai!” (I can!), and “Mai pen rai” (No problem”.) When a doctor is looking at you they are not just judging the extent of the cut and where the blood is flowing – they are looking at your response. If you are freaked out at all they will call the fight.
The Thai Hospital Stitch Experience
I’ve only received stitches at a hospital twice. After Doogie Howser left me with not enough stitches holding my face together, we stopped into a hospital at 4 AM when we got back to Pattaya to get some more sutures put in. It was the graveyard shift and it was all very strange. They wanted 10,000 Baht ($281 USD) to give me two more stitches. No way. So that was a time I didn’t get hospital stitches, but recently I took off my bandage the night after my fight and saw that the stitches were only on one side and the cut was completely open. I was going to superglue it or just leave it with some butterfly bandaids holding it together, but Kevin said I had to go get stitches. Maybe because it wasn’t the graveyard shift, these stitches were only 2,000 Baht ($56 USD), so my fight purse basically paid for them. I don’t have medical insurance, so that price is due to that and I don’t know what the cost is with traveler’s insurance. It was all women buzzing around me, not very concerned about the cut until I laid out on the table and the nurse saw all the other scars on my forehead. Then she was all worried and I had to explain (again) that I’m a fighter, which actually got her really interested and she asked me a million questions. The cut was two days old at this point and I’d kept it clean, so the doctor just came in and did a short assessment before going to work. She wanted to give me a tetanus shot, which I refused (due to cost, really) and ended up giving me local anesthetic without telling me first. I’ll say this: the one time I got the anesthetic by a ring doctor it didn’t seem to make any difference in the pain at all. But this time, maybe because it was days after the cut and I wasn’t coming right out of a fight with my adrenaline crashing, it made a huge difference and I didn’t feel the sutures at all. She gave me 3 stitches and they’re the most beautiful, tight stitches I’ve ever had. Again, this was 2 days later, so maybe that affects the capacity to close it up because the skin is different, not swollen, etc. But really, these are some great stitches.
Anesthetic vs no-Anesthetic
When you get stitches ringside, it’s straight out of the ring. Your adrenaline is still pumping and that helps with the pain a lot. If you need a lot of stitches or if it requires a lot of preparation time, your adrenaline will start to wear off and the pain is pretty bad. You’re crashing and having to sit still and the nerves in your head all run upward, so if you’re getting stitches on your forehead it will feel like you’re being cut a few inches up your scalp from where they’re actually going. It’s just nerves, but it can be difficult. If you lost, the adrenaline dump is deeper and the stitches feel more painful; a victory buzz goes a long way.
The one time I got anesthetic after a fight it didn’t make a big difference. I don’t think I felt the “zing” up the nerves of my scalp the way I do without the anesthetic, but I definitely still felt those stitches. I don’t know if it’s that the dosage is smaller ringside (costs?) or if the adrenaline messes with it’s effectiveness. It was underwhelming enough that when my stitches reopened two weeks later in a fight and the doctor offered anesthetic I told him not to bother.
But at the hospital, yeah – that anesthetic was awesome.
Some Facts About Scarring
Cuts leave scars. Sorry folks, it’s the obvious statement but it needs to be said. Your cut will heal and the scar will be really red for a couple months, then it fades and flattens. The healing time and overall result depends a great deal on your own skin. More pigment means you might keloid, which is the thick, raised scar tissue. Stitches help to reduce keloid scarring anyway, since the two sides are pulled together, but if there’s a gap at all it will scar more.
When you first take the stitches out the cut will look awesome. It will just be a thin, pink line and you’ll think, “man, this is great.” But the skin relaxes and the line gets a bit wider as a result. You can use aloe vera, vitamin E oil, Hirudoid cream, or silicone patches to reduce scarring – in terms of beauty aids, Hirudoid cream and aloe vera have very good reputations, but I was warned by Sifu McInnes don’t use these as a fighter. They will breakdown the scar, and promote weakness, leading to future cuts. So any beauty treatment of scars, especially early on in the healing process, needs to be also thought of from the perspective of maximal protection, as a fighter. I personally don’t know how effective all of these things are, I don’t use them, but I do know that the biggest difference you can make in curbing the scarring is to stay the hell out of the sun. Wear a hat, stay in the shade, wear sunscreen on the scar, etc. A little bit of UV exposure will break down the scar a little bit, but I’m talking very little exposure – like, the incidental exposure you get by forgetting to wear a hat when you go get the mail from the box. That kind of thing. Don’t sunbathe or go running without a hat if you want to keep your scars in check.
The line will stay a little raised or indented for a few months, but after about 3-4 months the scars start to disappear. They flatten out and get lighter, and probably you’re just used to seeing them on your face by now so you don’t notice them as much either. It’s part of your life now, and while that won’t always be fun, they can be a point of pride if you choose to view them that way.
Complications While they are In
I’ve had a lot of complications and I can only speak to my own experience. I don’t hang out with plastic surgeons or doctors, so I don’t know what’s good or bad or even normal. But if you experience any of these things, they’re normal enough that there are two of us. Sometimes, maybe due to training with the stitches but maybe it happens anyway, you’ll get bruising underneath the line of the scar. You’ll see it turn dark purple from the bleeding under the skin. You can just apply some heat to this and let it go away on its own – sometimes it will only be in one spot if you received impact on the scar at all.
However, there can be more dramatic subdermal bleeding that – if you choose to do so – can be drained. I use a hypodermic needle (you can buy these from pharmacies here, they’re sterile and come individually packaged) to pierce the line of the scar right over the purple spot, which is essentially a blood-blister. Then I very gently press the sides of the skin around the scar to urge the blood out. When the blood comes out it’s partially clotted, so the color is dark and the consistency is like honey or jelly. It should only be dark for blood, it shouldn’t be chunky.
Another subdermal issue will appear almost as a whitehead in the line of the scar. When is is happens you’ll almost always feel fluid or a hard spot on the side of the scar itself. Use the pads of your fingers to press around and you’ll feel either a pillowy area of skin, like a waterbed almost, which is fluid under the skin that can be drained through the needle pierce; or you might feel a hard spot, which is likely pus. If you have a whitehead in the scar, you can stick the needle right into the white spot (alternately hot compresses could also open the head). If there’s no white spot, do the best you can to pick an area right near (not right over) the hard spot and pierce that (preferably in the line of the scar) and then gently press around. The pus should be white, or off-white, but definitely not green or yellow. Green or yellow means you have an infection and you need to go get that cleaned. If you have a lot of pus, even if it’s not a bad color, you might consider going on antibiotics for 5 days as a precaution.
The When and How of Antibiotics in Thailand
I use Doxycycline or Amoxicillin, depending on what the pharmacy hands me. I definitely try to avoid taking antibiotics if I don’t have to, but I consider an infection a “have to” situation. Unfortunately, in Thailand everything is treated with antibiotics. If you go into a pharmacy with virtually any ailment at all, antibiotics are given. While they are absolutely overused here in Thailand, you also have to consider that you are living in a tropical climate where the risk of infection is actually very high. In many areas of the west we can get a scrape and basically leave it untreated with no ill effects, but in tropical climates even small cuts (bug bights, scratches, exposure to staph) can result in really nasty infections if you don’t treat them properly. So, on the one hand: don’t overuse antibiotics because it’s not good for you personally or the population generally. However, don’t underuse antibiotics when you have risk for infection or already have infection because that can be incredibly dangerous as well.
With more experience I’ve come to know the “normal” sensations of pain, ache, and swelling in a cut that’s healing pretty well, versus the sensations of a cut that feels that it might be getting infected. But even without having repeated experience of stitches in your face, you use your intuition as a guide. For the first week, swelling that drains downward (if you have a cut over your eye, you’ll likely get a swollen eye or a black eye as the swelling around the wound drains under the skin in your face. Gross, but it’s fine), and the stitches will ache. After about 5 days, they’ll be pretty itchy as well. What isn’t normal is if the pain radiates out or is especially sensitive on one side. The cut will be a little red right around each suture, but if the redness is broad or spans the entire cut, this might be a problem. If the cut is hot to the touch or if you are running a fever, get on antibiotics right away. The typical antibotic cycle in Thailand is 5 days 500 mg 4 times a day.
When Stitched Areas Reopen in Fights
The longer your cut has been healed the less likely it is to reopen in that same spot, but because scar tissue is thicker than the skin surrounding it, the difference in thickness makes the possibility for it to reopen along that line if you get struck, something that will always be a risk. Some spots on the face are more likely to reopen, like around the eyes and eyebrows (check out John Wayne Parr’s stitch graphic (below) and you’ll see it’s a focused, recurring area for him), whereas anything on your scalp is less likely to come in contact with strikes at the same rate.
When your cut does reopen, it tends to stay along the same scar with maybe a secondary break branching off. One time my cut reopened exactly where it was; one time it reopened just at the bottom with a secondary branch into the eyebrow; and one time the cut wasn’t fully healed yet and just a little contact made the area very swollen and then it reopened by tearing as I rubbed my head against my opponent in the clinch – not from a strike, but from tension. That sucked, but it was basically just setting myself two weeks back in the healing process from when I first got the cut.
When they reopen it seems like it’s a bit harder for the doctors to stitch them again. I reckon this is due to the swelling and the re-tear affecting the quality of the skin along its edge. So, in my experience the stitches I’ve gotten on a reopened cut weren’t so great and in some cases were totally useless. Perhaps it’s better to wait until the swelling goes down before restitching a re-opened cut. If you’re getting stitches from a ringside doctor it’s possible that waiting isn’t in the cards for you. When my cut re-opened in this last fight the doctor spent a good 15 minutes just pressing on the swollen bulb on my forehead, trying to get it down. That was more painful than the stitches and ultimately the stitches ended up only on one side of the tear. The stitches I got two days later were fantastic but there was no swelling at that point. So, I don’t know – maybe figure out a way to wait until the swelling goes down before stitching up a re-opened cut – I’m not sure that is feasible in many circumstances.
Here is a video of my last fight when a somewhat “fresh cut” (14 days) reopened in the very final seconds of the fight:
What Cuts Mean for Women in Thailand
I get a lot of shit for my cuts. People who are watching me in the ring get very excited because I keep fighting and am generally smiling afterward; gamblers and viewers love that. But they’re not badges of honor here, socially; a cut is a mistake and having multiple cuts means you haven’t learned from that lesson. Pi Nu was initially very upset by my cuts. To be fair, I’d never had any on my face (they were all in my hairline) until my Yokkao fight against Lommanee, and then I received 28 stitches, all in my forehead and all at once. It was a dramatic change to my visage and Pi Nu didn’t know me very well at that point (I’d been training as a guest at Petchrungruang for about a month) and the fight was technically on his watch, even though he wasn’t there. But of all the people who have a stake in me as a fighter, Pi Nu has come around more than anybody to support me and acknowledge my tenacity as a positive trait, rather than a flaw. He also is the first (and so far only) Thai person to acknowledge that I’m more prone to being cut in fights because I so often fight bigger, taller opponents and the angles make a big difference. He’s not proud of the cuts by any stretch, but I do feel like he’s proud of my willingness to keep going even when this risk is so high.
Most Thai female fighters do not not fight in a forward, muay khao, clinch style in part because of the risk to the face. I wrote a little about the western aesthetic concerns in Risking Your Beauty
I have noticed that the shit I get for my cuts is not applied to male fighters. There is a kind of head-shaking that accompanies the story anytime a fighter is cut in a fight, but the staring and pointing out and lecturing I get is never, ever offered to the western men I see with stitches in their faces. Ever. Thailand is a very non-confrontational culture, but at the same time it’s very open to public commentary on things that polite westerners wouldn’t voice. It’s considered crass to many Americans to, upon meeting someone for the first time, immediately point out the scar on someone’s face or stare and point at a missing finger, not even asking what happened but simply stating, “you are missing a fighter.” But that’s all pretty normal here. It may not be polite here either, but goddamn… it’s common. But I do think it stands out on me more than it would on a man, simply because it goes against what is considered valuable to and in a woman. I think that’s true in the west as well. A man with a scar on his face is intriguing, a woman with a scar on her face is damaged. It’s the world we live in.
But I’ll also say that there is an immediate legitimacy that my scars, my body and my tattoos offer when I come in contact with new people who want to know why I look so strange. They look at my body or my tattoos or my scars and they just have this huge cartoon question mark floating like a though bubble over their heads. But when I say I’m a nakmuay there’s this immediate oh! that, if I looked different, might be a really? But there’s no questioning of it. They can see from the scars that I’m really fighting. Of course, the number of the scars leads people to imagine these really beautifully and dramatically executed elbows, slicing me open in fights; other than with Lommanee, that’s not the case. With nearly every cut it’s been a matter of being caught by a sloppy elbow in my clinch-entry; when you watch the videos of my fights you can barely pick out where the cuts are happening, or not at all. It’s not fancy and dramatic.
Ultimately, though, how I respond to these cuts and scars are how others will eventually interpret them. And I see them as signs of my dedication. With over 125 fights, and as a Muay Khao fighter, some cuts are bound to happen. My response to the stitches has become a consistent reply, “chee-wit nakmuay,” (the life/fate of a fighter). Nine times out of ten I get a smile from this, sometimes a thumbs up or a gambler repeating the phrase a few times out loud. This is my life, my fate. And I embrace it.
I’ve put together a page celebrating the bloodied faces of female Muay Thai fighters all over the world, trying to help change the meaning of these images. Give it a look and share if you’d like to help:
and I’ve written about the stigma of the bloodied female face here:
If you have a stitches from a cut and you have a question for me, I’d be glad to answer it from within the limits of my experience. You can email me at sylvie AT 8limbs.us or message me on Facebook if you like. Or, even better, you can post your question (and a photo if you have one) to this Roundtable Forum thread and the community and I can share our experience.
featured image photo credit: Tom Brown of MuayThaiAction.com