From the Guidelines
External Traumatic Abrasions or Puncture wounds (ETAP) and conditions requiring sutures can result from various etiological factors, including sharp object injuries, blunt force trauma, animal or human bites, machinery accidents, and projectile injuries, with the most recent evidence suggesting that occupational hazards and recreational activities are significant contributors to these injuries 1.
Etiological Factors
The possible etiological factors for ETAP or conditions requiring sutures include:
- Sharp object injuries (knives, glass, metal edges)
- Blunt force trauma (falls, sports injuries, vehicle accidents)
- Animal or human bites
- Machinery accidents
- Projectile injuries
- Environmental factors like road surfaces during falls or accidents
- Occupational hazards in construction, manufacturing, and agriculture
- Recreational activities and sports, particularly contact sports or those involving equipment like skateboards or bicycles
- Assault or violence
Management and Treatment
When treating these wounds, thorough cleaning with saline or mild antiseptic solutions is essential before considering closure methods. Tetanus prophylaxis should be administered if the patient's immunization status is outdated (typically a Tdap booster if more than 5 years since last dose) 1. Deep or contaminated wounds may require prophylactic antibiotics such as amoxicillin-clavulanate (875/125 mg twice daily for 5-7 days) or, in case of penicillin allergy, clindamycin (300-450 mg four times daily) 1.
Prevention of Infection and Promotion of Healing
These injuries require prompt medical attention to prevent infection, ensure proper healing, and minimize scarring. The use of advanced wound therapy, such as negative-pressure wound therapy, growth factors, bioengineered tissue, and stem cell therapy, may be necessary for chronic or complex wounds 1. It is essential to follow the five basic principles of ulcer treatment, including offloading of plantar ulcerations, debridement of necrotic tissue, revascularization of ischemic wounds, management of infection, and use of physiologic, topical dressings 1.
From the Research
Possible Etiological Factors for ETAP or Stitches
The possible etiological factors for External Traumatic Abrasions or Puncture wounds (ETAP) or conditions requiring sutures (stitches) can be categorized into several factors, including:
- Nutritional factors: Malnutrition may alter the inflammatory response, collagen synthesis, and wound tensile strength, all of which are crucial for wound healing 2.
- Exercise-related factors: Exercise-related transient abdominal pain (ETAP), commonly referred to as 'stitch', is an ailment well known in many sporting activities, especially those that involve repetitive torso movement with the torso in an extended position, such as running and horse riding 3.
- Physiological factors: Several theories have been presented to explain the mechanism responsible for the pain, including ischemia of the diaphragm; stress on the supportive visceral ligaments that attach the abdominal organs to the diaphragm; gastrointestinal ischemia or distension; cramping of the abdominal musculature; ischemic pain resulting from compression of the celiac artery by the median arcuate ligament; aggravation of the spinal nerves; and irritation of the parietal peritoneum 3.
- Wound-type specific factors: Different wound types, such as burn wounds, pressure ulcers, diabetic ulcers, venous ulcers, and hypertrophic scars, may have specific etiological factors and require different nutritional interventions 4.
Wound Healing and Nutrition
Nutrition plays a crucial role in wound healing, and nutritional deficiencies can impair the healing process 2, 4. The use of specific nutritional interventions, such as vitamin and mineral supplementation, may improve the outcome of certain wound types 4.
Exercise-Related Transient Abdominal Pain (ETAP)
ETAP is a common condition that affects many athletes, and its etiology remains to be fully elucidated 3, 5. Several theories have been proposed to explain the mechanism responsible for the pain, including irritation of the parietal peritoneum, ischemia of the diaphragm, and stress on the supportive visceral ligaments 3. Strategies for managing the pain are largely anecdotal, and further investigations are required to fully understand the condition and develop effective prevention and treatment strategies 3, 5.