Tobacco exposure and wound healing in head and neck surgical wounds

Abstract

Objective Smoking impairs wound healing, yet the underlying pathophysiological mechanisms are unclear. We evaluated tobacco-altered healing in head and neck surgery by studying the association between biomarkers and tobacco exposure, as well as cutaneous perfusion by smoking status. Study Design Prospective cohort study, tertiary/academic care center, 2011 to present. Methods Patients who required head and neck surgery were enrolled prospectively. Postsurgical drain fluid was collected 24 hours postoperatively. Biomarkers associated with postulated mechanisms of smoking-impaired healing were assayed. These included interleukin-1, -6, and -8; tumor necrosis factor- alpha; transforming growth factor-beta; epidermal growth factor (EGF); basic fibroblastic growth factor (bFGF); C-reactive protein; vascular endothelial growth factor; soluble FMS-like tyrosine kinase-1 (sFLT-1); and placental growth factor. Tobacco exposure and clinical outcomes were recorded. Two sample two-sided t tests evaluated the differences in cytokine levels by tobacco exposure. In a second cohort, cutaneous vascular assessment via indocyanine green angiography was compared by smoking status. Results Twenty-eight patients were enrolled with drain fluid collection. Twenty-one subjects were current/former smokers, whereas seven were never smokers. EGF was higher in never smokers than smokers in a statistically significant manner (P = 0.030). Likewise, sFLT-1 was significantly higher in never smokers (P = 0.011). Cutaneous angiography revealed nonsmokers to have significantly higher cutaneous perfusion than smokers. Conclusion In this head and neck surgical cohort, significantly higher EGF and sFLT-1 levels in wound fluid were associated with never smoking, suggesting that smoking has adverse effects on the inflammatory phase of wound healing. Cutaneous angiography supports the detrimental effect of smoking on skin perfusion. These findings suggest the need for further study as well as therapeutic targets for smokers undergoing surgery.

Nicotiana tabacum (Tobacco) Promotes Wound Healing in Diabetic Rats

“…The EGF, which is normally secreted by platelets, fibroblasts and macrophages subsequently stimulates keratinocyte migration and proliferation. Some human studies carried out in smokers have documented reduced levels of EGF [9,22,23]. This could explain the delayed reepithelization that was observed in all the tobacco groups but slightly more pronounced in the diabetic groups (TPD and TED) in our study.…”

“…Tobacco smoking is said to impede the inflammatory phase of wound healing by reducing cellular chemotaxis, migration and oxidative bacterial phagocytosis [9][10][11][12]. It also retards the proliferative phase of wound healing by reducing fibroblast proliferation and migration with consequent diminished collagen synthesis [13][14][15].…”

Effectiveness of a Screening Tool for Early Identification of Malnutrition in Patients with Head and Neck Cancer

“…In addition, it was observed that participants who were non-smokers and underwent primary surgical closure were related to decreased length of hospitalization stay. This can be attributed to shorter surgery time, extend of surgery and better wound healing in non-smokers [16]. This study has demonstrated the effectiveness of preoperative nutritional screening and effects of early nutritional interventions in preventing postoperative SSI and decreasing the length of hospitalization stay.…”

Excessive inflammation portends complications: Wound cytokines and head and neck surgery outcomes

“…After surgery, the postoperative wound contains an exceedingly complex, physiological network of cells and molecular processes to repair the effects of trauma and heal the wound. Each overlapping phase of healing is essential to the next and to the ultimate outcome, and thus, when disruptions occur, an acute wound may devolve into a chronic wound . Acute wound healing is initiated with the hemostatic phase, during which platelets arrive and a fibrin scaffold is deposited.…”

“…The present work was performed in the same manner as previously described by our group . Regulatory approvals were granted by our institution's institutional review board to evaluate this patient population.…”