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Smoking and wound healing

  • Paul Silverstein
    Correspondence
    Requests for reprints should be addressed to Paul Silverstein, M.D., 3301 N.W. 63rd Street, Oklahoma City, Oklahoma 73116.
    Affiliations
    University of Oklahoma Health Science Center, Oklahoma City, Oklahoma USA
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      Abstract

      The association between cigarette smoking and delayed wound healing is well recognized in clinical practice, although extensive controlled studies have yet to be performed. The documented effects of the toxic constituents of cigarette smoke—particularly nicotine, carbon monoxide, and hydrogen cyanide—suggest potential mechanisms by which smoking may undermine expeditious wound repair. Nicotine is a vasoconstrictor that reduces nutritional blood flow to the skin, resulting in tissue ischemia and impaired healing of injured tissue. Nicotine also increases platelet adhesiveness, raising the risk of thrombotic microvascular occlusion and tissue ischemia. In addition, proliferation of red blood cells, fibroblasts, and macrophages is reduced by nicotine. Carbon monoxide diminishes oxygen transport and metabolism, whereas hydrogen cyanide inhibits the enzyme systems necessary for oxidative metabolism and oxygen transport at the cellular level. Slower healing has been observed clinically in smokers with wounds resulting from trauma, disease, or surgical procedures. The reduced capacity for wound repair is a particular concern in patients undergoing plastic or reconstructive surgery. Compared with nonsmokers, smokers have a higher incidence of unsatisfactory healing after face-lift surgery, as well as a greater degree of complications following breast surgery. Smokers should be advised to stop smoking prior to elective surgery or when recovering from wounds resulting from trauma, disease, or emergent surgery.
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      References

        • Mosely LH
        • Finseth F
        Cigarette smoking: impairment of digital blood flow and wound healing in the hand.
        Hand. 1977; 9: 97-101
      1. The health consequences of smoking: cardiovascular disease. A report of the surgeon general. U.S. Department of Health and Human Services, Rockville, Maryland1983
        • Sherwin MA
        • Gastwirth CM
        Detrimental effects of cigarette smoking on lower extremity wound healing.
        J Foot Surg. 1990; 29: 84-87
        • Nolan J
        • Jenkins RA
        • Kurihara K
        • Schultz RC
        The acute effects of cigarette smoke exposure on experimental skin flaps.
        Plast Reconstr Surg. 1985; 75: 544-549
        • Mosely LH
        • Finseth F
        • Goody M
        Nicotine and its effect on wound healing.
        Plast Reconstr Surg. 1978; 61: 570-575
        • Rees TD
        The acute effects of cigarette smoke exposure on experimental skin flaps: a discussion.
        Plast Reconstr Surg. 1985; 75: 550-551
        • Piper DW
        • McIntosh JH
        • Hudson HM
        Factors relevant to the prognosis of chronic duodenal ulcer.
        Digestion. 1985; 31: 9-16
        • Siana JE
        • Rex S
        • Gottrup F
        The effect of cigarette smoking on wound healing.
        Scand J Plast Reconstr Surg. 1989; 23: 207-209
        • Rees TD
        • Liverett DM
        • Guy CL
        The effect of cigarette smoking on skin-flap survival in the face lift patient.
        Plast Reconstr Surg. 1984; 73: 911-915
        • Riefkohl R
        • Wolfe JA
        • Cox EB
        • McCarty Jr, KS
        Association between cutaneous occlusive vascular disease, cigarette smoking, and skin slough after rhytidectomy.
        Plast Reconstr Surg. 1986; 77: 592-595