Transdermal nicotine patch enhances type I collagen synthesis in abstinent smokers

Abstract

Cigarette smokers deposit less collagen, expressed as hydroxyproline, in granulation tissue than nonsmokers. We studied the effect of abstinence from smoking and transdermal nicotine patches on deposition of hydroxyproline, proline, type I procollagen, and total proteins. Fifty-four healthy smokers were studied during 10 days of smoking and again from days 10 to 20 following smoking cessation. After the first 10 days of abstinence they were randomized to double-blind treatment with transdermal nicotine patches of 25 mg/day or placebo for a period of 10 days. During this period and during smoking, an expanded polytetrafluoroethylene tube was implanted into the subcutis. Following removal of the implant, total amino acids and peptides were extracted. Hydroxyproline and proline were analyzed by high-pressure liquid chromatography, type I procollagen was analyzed by enzyme-linked immunoassay, and total proteins were determined colorimetrically. In the 39 subjects who complied with the study protocol, abstinence from smoking did not affect the deposition of hydroxyproline, proline, type I procollagen, or total protein in the implants. During abstinence, the type I procollagen level increased by 18% in the transdermal nicotine patches group and decreased by 10% in the placebo group (p<0.05). We conclude that 20 days of abstinence from smoking does not affect collagen deposition in granulation tissue. However, in abstinent smokers, transdermal nicotine patches appears to increase type I collagen synthesis.

Acute Effects of Nicotine and Smoking on Blood Flow, Tissue Oxygen, and Aerobe Metabolism of the Skin and Subcutis

“…This view is supported by the fact that the blood levels achieved by nicotine infusion were similar to the levels previously achieved by nicotine-replacement drugs [34], which have been shown not to affect wound healing unless administered in toxic doses [35,36]. In fact, recent animal studies have found that nicotine appears to stimulate wound healing and angiogenesis [37,38], and human studies of abstinent smokers using transdermal nicotine patch have found normalized digital blood flow, enhanced collagen synthesis, and a nonexistent effect on incisional wound complications [17][18][19].…”

“…A more recent study, however, has shown that the digital perfusion normalizes within 1 week after transdermal nicotine patch-assisted smoking cessation [17], and our group has disproved the hazardous effect of transdermal nicotine patch on wound healing and incisional wound infection in abstinent smokers [18,19].…”

“…Eight subjects [27 years (range 21-37)] were daily smokers [20 cigarettes per day (range [15][16][17][18][19][20][21][22][23][24][25]], and another eight subjects [28 years (range 21-34)] were ex-smokers as they had abstained for 10 months (range 4 -11) prior to the study. Ex-smokers with a smoking history of one pack of cigarettes per day prior to smoking cessation were selected as opposed to never smokers, who would not have been able to complete the study and whose participation would have been unethical.…”

Tobacco smoking and dermatologic surgery

“…However, use of the nicotine patch or gum was not associated with decreased wound-tissue oxygen tension, thought to be a result of the reduced levels and rate of nicotine absorption in the patch or gum compared with smoked nicotine. 13,24 Two studies examined the ideal time for nicotine withdrawal to prevent necrosis in rats. Forrest et al 17 demonstrated that when nicotine injections were withheld for 2 weeks before surgery, flap survival was similar to controls.…”

“…For heavy smokers who are unable to quit, it may be more practical to recommend cutting down to less than 1 PPD or switching to nicotine replacement therapy during this period, as either method had negligible risk in several studies. 13,24,62 Regarding surgical technique, we recommend limiting the use of grafts or flaps in heavy smokers, and undermining in the deep subcutaneous plane to preserve the blood supply from the subdermal plexus. For reconstruction requiring interpolated flaps, consider using the delay phenomenon to increase flap viability and maximize surgical outcomes in smokers.…”