Smoking and wound healing.

Posted by Jane Sutton on 27 April 2015

“Does it really matter if I don’t stop smoking prior to my surgery?”

There are many reasons why it is recommended that patients stop smoking. People are aware of the general risks to their health such as heart disease and cancers, however smoking also has a direct affect on wound healing after surgery. Here are some of the many ways in which smoking is detrimental to wound healing.

• Collagen is a protein that is responsible for the strength and elasticity of the connective tissue of the skin. Collagen production is decreased in smokers. Overall the mean amount of collagen is less in the wound of a smoker, making the wound weaker, less resilient and more likely to break down. Potentially requiring further surgical or medical intervention.

• Nicotine increases platelet adhesion, therefore increasing the risk of clot formation in the small vessels of the injured area.

• Nicotine inhibits red blood cell production as well as macrophage and fibroblast proliferation. These are important cells responsible for delivering oxygen, cleaning up and preventing infection and providing the building cells that heal the wound.

• Smoking produces Carbon Monoxide. The carbon Monoxide enters the blood cells and reduces the amount of oxygen that can be carried to the wound. It takes 3 days for Carbon Monoxide to be cleared from the blood stream following a cigarette.

• Smoking causes significant vasoconstriction (shrinking) of the small vessels within the wound reducing blood flow. This will remain the case for up to 50 minutes after the cessation of each cigarette.

• Wound dressings can absorb cigarette smoke, just like furniture, curtains and cars can harbour cigarette fumes. This means that patients trying to heal should not be around smokers. Passive smoking is really problematic. It is no longer acceptable to smoke around babies or other vulnerable peoples. People with healing wounds should be given the same consideration.

• The risks associated with smoking are significantly increased when the wound is in the extremities (hands, feet or head) or in tissues with poor blood supply (adipose/fatty tissue). In our field, Plastic and Reconstructive surgery, we live and breathe in the peripheral areas. Lack of blood flow and oxygen to these areas seriously affects our ability to ensure you successful healing and a great result.

• It is a known fact that the longer that a wound takes to heal, the greater the chance of hypertrophic (red, raised, lumpy) scarring.

• Other systemic issues such as diabetes, obesity, poor nutrition will compound the affect of smoking on wound healing.

Therefore by ceasing smoking as soon as possible you will:

a) Improve the success rate of the surgery.

b) Reduce the chance of further surgical/medical intervention.

c) Reduce the time it takes for the wound to heal and therefore have less visible scaring.

d) Avoid creating wrinkles prematurely!!!

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