Plastic Surgery and Smoking

Coon, Devin; Tuffaha, Sami H.; Christensen, James H.; Bonawitz, Steven C.

doi:10.1097/prs.0b013e318277886a

Cited by 82 publications

(23 citation statements)

References 30 publications

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“…In another study on reporting as well as on smoking cessation adherence in a clinical setting, Coon et al investigated patients before elective plastic surgeries: 33.5% of the 415 patients stated they had quit smoking, while 9.4% reported to have continued. 16 These results fall close to ours. Urinary cotinine samples revealed that of all the patients tested, 4.1% were positive for cotinine despite claiming to have quit smoking.…”

Section: Discussionsupporting

confidence: 90%

Validity of subjective smoking status in orthopedic patients

Bender¹,

Haubruck²,

Boxriker³

et al. 2015

TCRM

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PurposeIn this level 1 diagnostic study, we analyzed the validity of subjective smoking status and, as secondary research question, the smoking cessation adherence in orthopedic patients during a routine hospital stay of nonunion patients by measuring serum cotinine.MethodsWe included patients undergoing revision surgery due to nonunion of long bones. Patients were interviewed about their smoking status. Blood samples were taken from all the patients prior to surgery and for an additional 6 weeks following surgery. Serum levels of cotinine were measured, and coherence between subjective smoking status and objective cotinine analysis was evaluated.ResultsBetween March 2012 and August 2014, we enrolled 136 patients. Six of the 26 “previous smokers” (23%) and four of the 65 “nonsmokers” (6%) had serum cotinine above cutoff levels. In self-labeled smokers, serum cotinine levels averaged at 2,367.4±14,885.9 ng/mL (with a median of 100 ng/mL), whereas in previous smokers the levels averaged at 4,270±19,619.4 ng/mL (with a median of 0 ng/mL) and in the nonsmokers group the levels averaged at 12±53.9 ng/mL (with a median of 0.03 ng/mL). Overall, the subjective smoking status matched serum cotinine testing in 88% of the cases. Sensitivity was 79.6% and specificity was 93.1%. Ninety-one percent of the patients with preoperative positive serum values were still positive at follow-up.ConclusionIn this study, we could show that subjective smoking status in orthopedic patients is predominantly reliable as validated by objective cotinine measurements; however, patients who declare themselves as “previous smokers” are at elevated risk for underreporting continued smoking and patients who smoked preoperatively are at high risk for continuing their habit. In the future, caregivers should consider introducing effective treatments for smoking cessation to smokers and furthermore offer effective treatments to maintain smoking cessation in previous smokers during their routine consultation prior to orthopedic and trauma surgery.

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Section: Discussionsupporting

confidence: 90%

Validity of subjective smoking status in orthopedic patients

Bender¹,

Haubruck²,

Boxriker³

et al. 2015

TCRM

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“…Smoking is a risk factor in wound complications in the general plastic surgery population and especially those undergoing free flaps. 34 , 35 Because smoking is a modifiable risk factor, motivational coaching directed toward smoking cessation may be an important step in preventing recurrence. Our data indicate that surgeons should be cautious about offering pressure ulcer flap coverage in smokers, and patients should be counseled on the risks associated with smoking.…”

Section: Discussionmentioning

confidence: 99%

Flap Reconstruction for Pressure Ulcers: An Outcomes Analysis

Bamba

Madden

Hoffman

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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Background:Historically, complication rates after pressure ulcer reconstruction utilizing flap coverage have been high. Patients undergoing operations for pressure ulcer coverage typically have multiple risk factors for postoperative complications. The purpose of this study was to examine a large patient series in the pressure ulcer population to uncover objective evidence of the linkage between risk factors and outcomes after flap coverage.Methods:This study was a retrospective chart review of patients who underwent flap reconstruction for a pressure ulcer between 1997 and 2015. The characteristics of patients were analyzed to determine those who had complications such as pressure ulcer recurrence, wound dehiscence, and wound infection.Results:All patients (N = 276) underwent flap coverage of their pressure ulcers. The overall complication rate was 58.7% (162 patients). Wound dehiscence was the most common complication (31.2%), and the pressure ulcer recurrence rate was 28.6%. Multivariate regression for pressure ulcer recurrence revealed that body mass index <18.5 [relative risk (RR) 3.13], active smoking (RR 2.33), and ischial pressure ulcers (RR 3.46) were independent risk factors for pressure ulcer recurrence. Ischial pressure ulcers (RR 2.27) and preoperative osteomyelitis (RR 2.78) were independent risk factors for wound dehiscence. Diabetes was an independent risk factor for wound infection (RR 4.34).Conclusions:Our retrospective analysis revealed numerous factors that are associated with high rates of major postoperative complications. Risk factors must be taken into account when offering flap coverage, and risk-reducing strategies must be implemented in patients before pressure ulcer reconstruction.

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“…7–9 Tobacco use is associated with poor perfusion, delayed healing, reconstructive failure, and increased rates of reoperation. 7,8 Nicotine and carbon monoxide are associated with delayed healing and wound-related complications. It is recommended that patients be free of tobacco products for 1 month before surgery and for 2 weeks after surgery.…”

Section: Patient Selectionmentioning

confidence: 99%

“…By avoiding tobacco, wound-related complications could be reduced as much as 3-fold from 23.5% to 7.7%. 8 In patients who continue to smoke, the typical recommendation is to proceed with the mastectomy but refrain from proceeding with immediate breast reconstruction.…”

Section: Patient Selectionmentioning

confidence: 99%

Prosthetic Breast Reconstruction With Acellular Dermal Matrices: Achieving Predictability and Reproducibility

Nahabedian

2016

Plastic and Reconstructive Surgery - Global Open

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Summary:The use of acellular dermal matrices in the setting of prosthetic breast reconstruction has captured the attention of many plastic surgeons. The regenerative capacity of these materials has provided additional tissue support to the mastectomy skin flaps with the ultimate result of improving surgical and aesthetic outcomes. Despite the benefits, there remains a significant diversity with regard to outcomes with some surgeons reporting increased morbidity. The reasons for this are varied but ultimately related to differences in patient selection and surgical techniques. The purpose of this article is to provide strategies for using acellular dermal matrix to achieve success in a manner that is usually associated with outcomes that are predictable and reproducible.

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Plastic Surgery and Smoking

Abstract: Risk, II.

Cited by 82 publications

References 30 publications

Validity of subjective smoking status in orthopedic patients

Validity of subjective smoking status in orthopedic patients

Flap Reconstruction for Pressure Ulcers: An Outcomes Analysis

Prosthetic Breast Reconstruction With Acellular Dermal Matrices: Achieving Predictability and Reproducibility

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