When Anton Volchenkov’s face met the business end of Mike Richards’ stick in game 5 of the Stanley Cup finals, everyone recoiled in horror anticipating the damage that had surely been done. Everyone except fans of the Ottawa Senators. Ottawa had come to know and love Volchenkov in his ten years with the organization for huge hits and blocking shots (generally with his face). Imagine the horror that swept the Ottawa Valley when it became apparent that Volchenkov was not only hurt, he was actually bleeding – something previously assumed to be impossible.
Volchenkov hit the ice and was quickly hustled off with a towel held to his bleeding face. It was hard to tell what the injury was initially – it seemed likely to be another nosebleed, aka a normal day at the office in the NHL. He barely missed a shift, back on the ice in no time… Still bleeding?
“What the crap?” I thought.
“Is his nose still bleeding? Must still be bleeding.” I thought.
“Holy cats, he’s such a badass he’d rather just bleed than try to play with Rhino Rockets in.” I thought.
I was completely wrong, but let’s pause just long enough to discuss the Rhino Rocket, a fun little piece of equipment that stops a nosebleed, but makes you look like a tool.
The Rhino Rocket is a nose tampon. You anesthetize the inside of the nose, stuff the rocket in using the lovely blue applicator, and it expands to tamponade the bleeding area and absorb the blood (and snot – this becomes important later). The string hangs out of your nostril, because that’s what your doctor uses to pull that sucker back out. You get to sleep sitting up for a couple of days, then come back in 48 hours for what I thought had to be the most painful medical procedure ever. While it isn’t the most painful, it ranks high on the list of the most disgusting. Feel free to stop reading now if the snot I mentioned earlier made you queasy.
The first time I had to pull one of these out, I thought I was about to kill my patient. Surely this thing had to be glued in there with snot and blood. Surely the second I pulled it out the patient would simultaneously punch me, scream, start bleeding, and then die. I pretended to be cheerful and confident (and competent), as I squirted some saline up his nose in what I assumed was likely a futile attempt to dislodge 48 hours of accumulated snot and blood. I grabbed the string, closed my eyes, braced for impact, and slowly pulled the Rhino Rocket out. And nothing happened. It slid right out. Thank you snot and thank you KY they used when the put the rocket in. The next few minutes were spent wiping unreal amounts of disgusting snot off that poor guy’s face, and then peering up his nose to make sure the bleeder wasn’t bleeding any more.
But I digress…
Post-game the CBC did nobody (except me and a few other gross folks out there) a favour by showing a delightful close-up of the damage to Volchenkov’s face. Everyone’s favourite puppet Guts McTavish had the good grace to share a screen cap:
— Guts McTavish (@gutsmctavish24) June 10, 2012
What’s up with his FACE?
That’s not just a nasty lip laceration. That’s a nasty lip laceration with jagged edges, and it crosses the vermilion border. The vermilion border is something for which anyone who sutures faces should have a healthy respect. It’s the point at which face becomes lip. And if you don’t get its edges back together exactly perfectly, it shows. How do you fix these things? Carefully.
How to fix a face in four easy steps!
Step 1: Clean the heck out of it. Any laceration needs to be cleaned really, really well before you close it. A laceration from a nasty hockey stick that’s been touching ice that gets spit on especially. Copious rinsing with clean tap water or saline is actually just as effective (and less damaging to the tissues) as nasty painful disinfectants. A nice doctor anesthetizes the area before they start really getting into the cleaning process.
Step 2 (or step 1 if you’re nice): Anesthesia. The upper lip’s sensation is provided by the infraorbital nerve, which as the name suggests emerges from the skull just under the eye. A cut on the upper lip isn’t something that lends itself well to direct injection of anesthetic, since adding volume to a small area like that can distort the anatomy. Remember that vermilion border? You want it as normal as possible while you’re meticulously trying to piece it back together. All this adds up to what can easily be some pretty unpleasant anesthesia. You’re either getting a needle in the face just under the eye (not a chance in hell I’d let someone do that to me), or a needle inside your upper lip at the top of your gums (yes, please). Topical anesthetic inside the upper lip, and that injection can be a breeze. Remember that if you ever cut your lip and somebody comes at your face with a needle.
Step 3: Sew the inside. The key to a good lip repair, aside from matching the vermilion border, is to make sure all the layers are put back together. The first place to go is the actual inside of the lip. Not the slimy bits inside the mouth, but the actual inside of the lip (the part you’re not supposed to be able to see unless you ate Mike Richards’ stick). Absorbable sutures are used, and will dissolve on their own eventually.
Step 4: Sew the outside. The outside meaning both the skin of the face and lip, and the skin inside the mouth. The inside of the mouth is home to more absorbable sutures, and you’ll be warned not to mess with them with your tongue, but you will because you’re only human and nobody can help but mess with them. The outside face/lip skin is repaired with the most annoying suture material known to modern medicine. It’s nonabsorbable 6.0 or 7.0 suture (6.0 and 7.0 being the sizes). Suture that small not only comes on an annoyingly small needle, it’s so thin that it’s hard to see, and it loves to tie itself into a multitude of tiny little knots. It’s black magic. I have no idea how it happens, but getting through a 7.0 repair without getting tangled or dropping at least five f-bombs is an accomplishment.
The first stitch goes in the vermilion border, just barely on the face side of things. The wound edges have to be perfectly matched – the tiniest misalignment will be obvious once the lip heals. Once that’s done, you close the rest of the wound, and try not to frighten the patient with your extensive vocabulary of expletives. The non-absorbable sutures can come out in about 4 days, and obviously the absorbable ones are allowed to do their own thing (stop messing with those, dammit).
Damn bro, nice lip.
Craig Custance treated us to an after photo of Volchenkov, and I nearly fainted at the beauty of the laceration repair:
Anton Volchenkov freshly stitched up. Ten stitches total. twitter.com/CraigCustance/…
— Craig Custance (@CraigCustance) June 10, 2012
Perfectly matched vermilion border, jagged cut pieced back together, and they didn’t even screw up the mustache portion of his playoff beard. His lip is swollen, but not grotesquely so. The official word was seven stitches on the outside and three on the inside. I’d have probably put in about forty-seven stitches and taken a year to do it, so whoever fixed this is on my “Wow, you’re a badass!” list.
Whether he’s a Stanley Cup champion or not, Anton Volchenkov clearly remains the champion of being much tougher than anyone you know. He played through a big gross lip laceration, and came out of the repair looking like, if not a million bucks, somewhere in the neighbourhood. I can’t help but wonder if he got the needle in the face or inside the lip though. My guess is if it was the face-needle he handled it at least 5000% better than any of us would have.