Twice-Daily Topical Honey versus Povidone-Iodine for Wound Care after Mastectomy with Axillary Lymph Node Dissection for Breast Cancer: A Randomized Controlled Trial at Bogodogo University Hospital, Ouagadougou, Burkina Faso

Abstract

Background: Wound complications can complicate recovery after mastectomy with axillary lymph node dissection. Evidence comparing twice-daily topical honey with povidone-iodine in this setting remains limited. Aims: To compare twice-daily topical honey with povidone-iodine for the care of the surgical wound after mastectomy with axillary lymph node dissection for breast cancer. Study Design: Single-centre, open-label, two-arm, parallel-group randomised controlled trial with blinded assessment of the primary outcome. Place and Duration of Study: Department of Gynaecology-Obstetrics and Reproductive Medicine, Bogodogo University Teaching Hospital, Ouagadougou, Burkina Faso, from 1 October 2024 to 30 September 2026. Methodology: Women aged 18 years or older undergoing mastectomy or breast-conserving surgery with axillary dissection for histologically proven breast cancer were randomised 1:1, with stratification by neoadjuvant chemotherapy. After removal of the initial dressing on day 1–2, the honey arm received twice-daily application of honey and the control arm twice-daily application of 10% dermal povidone-iodine on the incision until complete healing. The primary outcome was time to complete healing, assessed on standardised photographs by an independent assessor blinded to allocation. Secondary outcomes were 30-day surgical site infection (SSI, CDC criteria), seroma, skin necrosis, dehiscence, pain during wound care, skin reactions and length of stay. Results: Of 176 randomised women (88 per arm), 174 (98.9%) completed 30-day follow-up. Baseline characteristics were comparable; 78.2% had stage III–IV disease and 94.8% had received neoadjuvant chemotherapy. Complete healing before day 14 occurred in 26.1% of the honey arm versus 4.7% of the povidone-iodine arm (relative risk, RR 5.62; 95% CI 2.03–15.57; p < 0.001), and by day 21 in 93.2% versus 82.6% (p = 0.037). SSI occurred in 1.1% versus 7.0% (RR 0.16; 95% CI 0.02–1.32; p = 0.063). Seroma (8.0% vs 22.1%; RR 0.36; 95% CI 0.16–0.81; p = 0.011), pain during wound care on day 7 (11.4% vs 48.8%; p < 0.001) and skin reactions (2.3% vs 16.3%; p = 0.001) were less frequent with honey. Length of stay did not differ. Conclusion: Compared with povidone-iodine, twice-daily topical honey after mastectomy with axillary dissection accelerated wound healing and reduced seroma, pain during wound care and skin reactions. The lower SSI rate did not reach statistical significance. Honey is an affordable and well-tolerated alternative that warrants confirmation in a larger multicentre trial.