Smoking Increases Facial Skin Flap Complications

Abstract

This study was undertaken to determine whether smokers have a higher risk of complications after reconstruction of facial skin defects. Ninety-one patients with facial skin defects reconstructed with local flaps were reviewed retrospectively. Thirty-eight (42%) were active smokers, 12 (13%) had not smoked for at least 1 year prior to surgery, and the rest were nonsmokers. Complications occurred in 23 patients (25%; 37% in smokers, 17% in ex-smokers, and 17% in nonsmokers; p < .03). All full-thickness skin losses and all cellulitis occurred in active smokers. We conclude that active smokers are at a higher risk for complications in facial skin flap surgery. That ex-smokers had a complication rate similar to that of nonsmokers suggests that part of smoking's adverse effect on skin flaps may be an acute phenomenon, and that smoking cessation for shorter (<1 year) periods of time before surgery may have a beneficial effect.

The effect of cigarette smoking on musculoskeletal‐related disability

“…Given that the menisci are provided with a limited blood supply in even the healthiest person, the biological effects of smoking (e.g., arteriolar vasoconstriction, cellular hypoxia, demineralization of bone, delayed revascularization, and immune suppression) [Amoroso et al, 1996b;Hoogendoorn et al, 2002] may further decrease the supply of nutrients to the damaged tissue and result in the interruption of the healing process and increase the risk of long-term dysfunction. Similar arguments have been espoused to explain the associations between smoking and poor wound healing, bone metabolism, low back pain (particularly related to a herniated disc), postoperative infection, and, in general, decreased healing of any injured tissue with limited vascularization [Kwiatkowski et al, 1996;Kinsella et al, 1999;Towler, 2000;Adams et al, 2001;Hoogendoorn et al, 2002].…”

“…As with any source of self-reported health behaviors, reporting biases stemming from under-reporting or recall deficiency are possible. Not having available a measure of years smoked among current smokers from the HRA prohibited the calculation of pack-years, although Kinsella et al [1999] findings suggest that the acute (rather than chronic) effects of smoking have a greater impact on healing mechanisms. Nonetheless, future studies that address the association between smoking and disability should be based on this preferred measure of cumulative cigarette smoking burden.…”

A Prospective Evaluation of the Incidence of Complications Associated With Mohs Micrographic Surgery

“…The rate of partial-or full-thickness skin flap necrosis was 12.1% (11/91). 25 The patients who were included in the otolaryngologists' study may differ substantially from the cohort examined in our current study. Because of the involvement of an operating room-based surgical colleague, it is possible that these wounds differed in size and complexity from typical Mohs surgical wounds.…”

“…Otolaryngologists performed a retrospective study of patients who underwent reconstruction of facial defects with skin flaps and sought to determine the potential effects of smoking on surgical complication rates. 25 The majority of the patients involved had tumors extracted using the Mohs technique, and the patients subsequently underwent repair by an otolaryngologist. One hundred eight consecutive patients were eligible for the study; however, 12 were excluded because of the presence of comorbidities that might negatively impact wound healing (eg, diabetes mellitus or previous radiation treatment).…”

Through-and-Through Mattress Suturing Versus Tie-Over Dressing in Full-Thickness Skin Graft Reconstruction

“…The association between cigarette smoking and graft necrosis has also been examined previously, with the incidence of graft necrosis observed in active smokers being reported as three times more frequent compared to a non-smoking population (15,16). In contrast to these findings, no association between smoking and graft failure was seen among this population, as only one of the 17 patients with graft necrosis was an active smoker.…”