Mary asked for suggestions:

<a mother of an 11 month old nursling has a gaping wound at the base of her nipple areola from her sweet daughter's bite.  She has been trying different positions for nursing, using APNO and saline washes (no signs of infection) and virgin coconut oil.  There has been no relief of pain. Pumping hurts worse. It has been 10 days since the bite. Does anybody have any tips for her?  She does not want to stop producing on that side, it is her most productive side.>


In addition to the other suggestions given, for starters, I think it's important to respect the wound healing process we have learned from the physiology of moist wound healing. (For instance, if someone were to receive a "gaping" knife cut, or a "gaping" burn from a curling iron, etc. would we even begin to imagine applying vacuum to the healing area 7-8 times daily for 20+ minutes?????)

 
I would suggest avoiding vacuum and using frequent hand expression, at least 1-2 cm behind the wound to avoid much movement of the epidermis and dermis (and the nerves therein) that would stress/disorganize the cellular processes taking place in the tissues in the healing area. 


This would still remove milk from the damaged side to maintain supply until completion of adequate healing for direct nursing.  Though vacum does not technically pull on the tissue, it seems to me that the normal response of the tissues trying to push toward the vacuum to neutralize it would result in disturbance of the newly forming cells and matrix during the healing process. This then no doubt requires some healing to start all over again after each pumping, thus prolonging the healing process. 


OTOH, hand expression (by the Marmet method at least, with simultaneous massage/compression of the upper breast) would put positive pressure directly on the undamaged deeper subareolar tissues and the milk deeper inside the subareolar ducts, propelling it forward inside the ducts with virtually no disturbance of the external healing tissues.


This case reminded me that I can still "feel" the distressing physical and psychological memories of pain from my own nipple damage half a century+ after the fact. This continues to remind me never to discount it, (though I am amazed that some people just don't seem to feel it the way I did.) The memories continue to motivate me to help others avoid such pain. 


K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer    Dayton OH

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