Research showing benefits of moist wound healing for chronic ulcers and burns doesn't translate into evidence-based management of nipple wounds
Wound healing protocols are often based on beliefs not evidence
Some international voices within dermatology research continue to point out that many wound healing protocols are rituals, based on beliefs, and not genuinely evidence based.
Optimal wound healing occurs when
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Factors that facilitate the process are present, and
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Impediments are controlled or absent.
This table shows why wound healing orthodoxy is not applicable to the specialised microenvironment of the lactation-related nipple wound.
Wound healing orthodoxy doesn't suit the specialised microenvironment of nipple wounds
| Beliefs about necessary steps in best practice wound healing | Evidence-based concerns | Relelvance to clinical breastfeeding and lactation support |
|---|---|---|
| Wound cleansing | Various cleansing techniques continue to be investigated in chronic wound research. There is no evidence that all wounds need cleansing. Cleansing could be detrimental to healing tissues | Instructions to avoid nipple scabbing so that the wound can be cleaned and treated with moist wound dressings (even cut out to size) is widespread. |
| Debridement | It is not proven that debridement accelerates tissue healing in cchronic wounds (except in certain recalciitrant sloughy wounds, which are rare). Debridement can worsen pain. Slough and exudate has cells, functional proteins and growth hormones which promote healing. | Fitting a wound-sized polymeric membrane dressing to a nipple ulcer means effectively debriding that ulcer many times a day, as the dressing is removed to breastfeed (if the woman is continuing to breastfeed). This does not help, and is likely to delay, wound healing. |
| Frequent dressing changes may delay complete epithelialization | Any manipulation of the wound bed impacts cells, growth factors, and the microbiome which are promoting wound closure, and may induce inflammation which could impede wound healing. Interactions in microbiome and multiple cell types involved in cutaneous wound healing regulates the immune response and promotes barrier restoration. | Best not to interfere with the biological microenvironment of scab development and frequent washing with breast milk and saliva in the infants mouth, which favours healing as long as the underlying cause of damage (repetitive mechanical microtrauma) is removed. |
| There is a difference between 'toxic' wounds (high protease levels) and 'physiological' wounds | 'Toxic' wound fluid should be cleansed and the wound debrided, but not those with a physiological wound fluid. | Nipple wounds during breastfeeding are not 'toxic' chronic wounds, like diabetic or vascular ulcers, nor are they like burns. |
Recommended resources
Interventions which don't help lactation-related nipple pain and wounds
Selected references
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Conde-Montero E, Moreau A, Schlager JG, Pastor D, Hafner J. Protocols in wound healing: evidence-based or mere rituals? International Wound Journal. 2024;21:e70062.https://doi.org/70010.71111/iwj.70062.
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Khattak S, Ullah I, Yousaf M. Advancements in hydrogels: a comprehensive review of natural, synthetic, and hybrid innovations for wound healing. International Journal of Biological Macromolecules. 2025;327:147270.
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Sams-Dodd J, Sams-Dodd F. Time to abandon antimicrobial approaches in wound healing: a paradigm shift. Wounds: a compendium of clinical research and practice. 2018;30(11):345-352.
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RETRACTION: Impact of Moist Wound Dressing on Wound Healing Time: A Meta-Analysis. Int Wound J. 2025 Apr;22(4):e70566. doi: 10.1111/iwj.70566. PMID: 40251140; PMCID: PMC12008009.