Active Wound Management (AWM) Stretches

This video provides a visual example of the different methods for performing an active wound management stretch after frenectomy (tongue tie surgery). Further down this page you will find information on active wound management stretches. To read more about tongue tie surgery at Enhance, please visit our Tongue Tie Clinic Information page.


Active Wound Management (AWM) Stretches

The tissue of an open wound following surgery will attempt to return (as close as possible) to its original character, with the outer edges of tissue normally migrating tightly together. Sometimes the skin/mucosa is pulled even tighter in the healing process (similar to how a cut on your arm might heal). This type of healing is known as healing by primary intention

During healing of a  frenectomy site, we wish to encourage healing by secondary intention which is where healing factors migrate from the outer edge of the wound to the centre. Thereby minimising the tightness.  If we are to avoid the process of healing by primary intention (and the associated tightness) and instead encourage healing by secondary intention, certain steps need to be taken. Accordingly, it is important that a thorough post-operative care protocol is followed to prevent healing that results in a return of restricted tissue, but rather maintains the freedom of movement provided by the initial surgery.

Breastfeeding is a very helpful function of the mouth that assists to minimise the rapid closure of wound borders (reattachment) post-surgery. However, the mechanism of breastfeeding alone does not provide adequate stretching (especially in sub-mucosal tongue ties) to prevent the outer edges of the wound from healing together rapidly to reform the restriction (also known as reattachment).

Therefore, even in breastfeeding infants, gentle (but thorough and firm) and regularly repeated pressure on the wound is strongly recommended to prevent primary intention healing and reattachment. We have found these stretches to be instrumental in minimising the reattachment of the frenum to its former position. The process can be very challenging for parents and baby – stretching of a wound can be very uncomfortable and the child will likely cry and will dislike the stretches (you are pressing on or beside a surgical area).  However, it is vital to keep in mind that the stretches are to promote optimum healing with minimal reattachment. You will be given post-operative instructions at your appointment and shown in our AWM stretches video. The stretches are a three second motion for each treated area ensuring the process is quick but thorough. You can then embrace, feed and comfort your baby as soon as it is done.  Making the stretch part of a game makes it easier to do.  We encourage parents to remember that they are doing the stretches FOR their child, not TO them.

Some infants/toddlers are provided with additional exercises by their body worker or lactation consultant to address certain muscle tone or habit issues.   It is important to note that AWM stretches are different from those that may be given to you from your lactation consultant or body worker and must be performed regardless of other exercises you may have been given. Please see the AWM stretches video to ensure you are performing the stretches correctly or call to ask after our next stretch clinic if feeling unsure.