The hazard of cigarette smoking following digital replantation

Harris, Gerald D.; Finseth, Frederick; Buncke, Harry J.

doi:10.1002/micr.1920010513

Cited by 29 publications

(11 citation statements)

References 7 publications

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“…A recent paper by Harris et al [8] reported on the possible hazard of cigarette smoking after microvascular surgery. Two similar cases of postoperative arterial insufficiency attributable to smoking after microvascular surgery have been seen in our unit.…”

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confidence: 98%

Effect of Nicotine on Blood Flow and Patency of Experimental Microvascular Anastomosis

1983

Annals of Plastic Surgery

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Nicotine is known to have deleterious affects on the cardiovascular system, causing vasoconstriction and increased blood pressure. A drop in blood-flow velocity in humans, endothelial damage in rats, and inhibition of platelet aggregation in rabbits' blood have all been shown experimentally. In this article two studies are described that investigate the effects of nicotine on microvascular anastomotic patency. In experiment 1, electromagnetic blood-flow recordings were made in the saphenous artery of the saphenous flap after intraartehal installation of nicotine. Decreased blood flow was consistently recorded up to a maximum of 72% of normal flow. In experiment 2, rabbit femoral arteries were anastomosed and the patency rates at three weeks checked after various combinations of pre-and postoperative intraperitoneal nicotine had been injected. There was no significant increase in thrombosis between the groups treated with nicotine and the control.Although no thrombosis occurred in these experiments, decreased blood flow was noted in the saphenous flap in the dog. This slowing of flow should predispose to thrombosis, especially if other factors associated with the vascular repair were suboptimal. It is concluded in view of this study and the observed clinical effects in 2 patients with microvascular transfer that smoking in the perioperative period should be avoided.Several authors have reported on the deleterious effect of smoking after peripheral vascular surgery [7,16]. A recent paper by Harris et al [8] reported on the possible hazard of cigarette smoking after microvascular surgery. Two similar cases of postoperative arterial insufficiency attributable to smoking after microvascular surgery have been seen in our unit. These cases and the dearth of experimental evidence prompted us to investigate the effect of nicotine, the principal active component of cigarettes, on blood flow and patency rates of experimental microvascular anastomoses.It is estimated that one-third of all adults in the United States and Australia smoke cigarettes, about 24.6% smoking more than one pack daily [1,17]. The adult per capita consumption of cigarettes is about 200 packs per year [1, 17]. Smoking is the single most preventable cause of death and it has been blamed for various cardiovascular disorders and lung cancer [17].Nicotine is a colorless liquid alkaloid. It is estimated that each cigarette yields 0.4 to 1.6 mg of nicotine [12], which stimulates the central and peripheral nervous systems with release of catecholamincs causing vasoconstriction, rise of blood pressure, and tachycardia [6].Sarin et al [13] showed that a 42% decrease in distal blood-flow velocity occurred in human volunteers after they had smoked one cigarette. Hladovec [9] demonstrated that nicotine caused endothelial injury in rats. Booyse et al [3] showed endothelial changes in rabbit aortas after nicotine administration. Brinson ct al [4] concluded that nicotine inhibited platelet aggregation in rabbit blood in vitro. Materials and MethodsThe first part of th...

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confidence: 98%

Effect of Nicotine on Blood Flow and Patency of Experimental Microvascular Anastomosis

1983

Annals of Plastic Surgery

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“….). That much said, less widely publicized findings show that delayed wound healing directly related to tobacco consumption in reconstructive surgery following excision of a tumor, in cosmetic surgery and in upper limb trauma is 20 to 50% more prevalent in smokers than in non-smokers [4,6,8,26].…”

Section: Discussionmentioning

confidence: 99%

“…These pathophysiological effects have been observed during clinical practice, particularly in would healing [3], abdominoplasty [4], breast reconstruction [5], digital replantation [6], face lifting [7,8] and breast reduction [9]. In free tissue transfer operations, tobacco accounts for an increased morbidity of donor sites at considerable social cost [10].…”

Section: Introductionmentioning

confidence: 99%

Urinary cotinine testing as pre-operative assessment of patients undergoing free flap surgery

Reinbold

Rausky

Binder

et al. 2015

Annales de Chirurgie Plastique Esthétique

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“…Zwei andere Studien konnten deutlich machen, dass das Rauchen von Zigaretten in der frühen postoperativen Phase zu einem Gefäßspasmus führt, der die Anastomosenheilung bedroht [20,22]. Alle Studien zusammen stimmen darin überein, dass Patienten nach einer Replantation das Rauchen untersagt werden sollte, um eine optimale Zirkulation zu garantieren.…”

Section: Replantationunclassified

Rauchen ist nachteilig für die Heilung von Knochen und Weichteilen

Hoogendoorn

Simmermacher

Schellekens³

et al. 2002

Der Unfallchirurg

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This article reviews the current body of knowledge on the adverse effects of smoking on soft-tissue and bone healing, with emphasis on tibial fractures in combination with severe soft-tissue injury. The pathophysiological effects are multidimensional, including arteriolar vasoconstriction, cellular hypoxia, demineralisation of bone, and delayed revascularisation. Several animal and clinical studies have been published about the negative effects of smoking on bone metabolism and fracture healing. These studies show that smokers have a significantly longer time to clinical union than non-smokers and a higher incidence of non-union. The negative effects of smoking gained increased interest among plastic and microvascular surgeons, because smokers have been shown to suffer higher rates of flap failure, tissue necrosis, and haematoma formation. Especially smokers presenting with an open tibial fracture will suffer the negative effects of their smoking behaviour, because these fractures are inextricably bound up with soft-tissue injury. Their fractures will need a significantly longer time to heal than in non-smokers, and will have a higher incidence of non-union. If microvascular surgery is to be performed, persistent smoking significantly increases the rate of postoperative complications, with wound infection, partial flap necrosis, and skin graft loss being more common. Cessation of smoking has both short- and long-term beneficial effects. Nowadays, there is strong evidence to be very insistent that patients presenting with a (open) tibial fracture should refrain from smoking immediately to promote bone healing and to lower the complication rate. In case of elective reconstructive procedures, patients should refrain from smoking at least 4 weeks before surgery. In both situations, cessation should continue during the full rehabilitation period.

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The hazard of cigarette smoking following digital replantation

Abstract: Two case histories are presented in which cigarette smoking in the early postoperative period following digital replantation led to vasospasm and thus compromise of the microvascular anastomoses.

Cited by 29 publications

References 7 publications

Effect of Nicotine on Blood Flow and Patency of Experimental Microvascular Anastomosis

Effect of Nicotine on Blood Flow and Patency of Experimental Microvascular Anastomosis

Urinary cotinine testing as pre-operative assessment of patients undergoing free flap surgery

Rauchen ist nachteilig für die Heilung von Knochen und Weichteilen

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