Advertisement

Tobacco smoking and dermatologic surgery

  • Jing F. Gill
    Affiliations
    Department of Dermatology, Dermatologic Surgery and Laser Center, University of California at San Francisco, San Francisco, California
    Search for articles by this author
  • Siegrid S. Yu
    Affiliations
    Department of Dermatology, Dermatologic Surgery and Laser Center, University of California at San Francisco, San Francisco, California
    Search for articles by this author
  • Isaac M. Neuhaus
    Correspondence
    Reprint requests: Isaac M. Neuhaus, MD, Department of Dermatology, Dermatologic Surgery and Laser Center, University of California at San Francisco, 1701 Divisadero St, Third Floor, San Francisco, CA 94115.
    Affiliations
    Department of Dermatology, Dermatologic Surgery and Laser Center, University of California at San Francisco, San Francisco, California
    Search for articles by this author
Published:October 29, 2012DOI:https://doi.org/10.1016/j.jaad.2012.08.039

      Background

      Cigarette smoking is the leading cause of preventable death and a major public health concern. Numerous clinical and experimental studies have examined the effect of nicotine on wound healing and surgical procedures, but there are limited published reports in the dermatologic surgery literature.

      Objective

      This article seeks to develop evidence-based recommendations regarding the effect of tobacco use in patients undergoing dermatologic surgery procedures.

      Methods

      This article reviews the existing published English-language literature pertaining to the effects of tobacco on wound healing and surgical complications.

      Results

      Tobacco use is associated with a higher incidence of postoperative complications including wound dehiscence, flap or graft necrosis, prolonged healing time, and infections.

      Limitations

      This review article only summarizes past reports and studies.

      Conclusion

      Recommendations for smoking cessation before dermatologic surgery are provided based on the available data.

      Key words

      To read this article in full you will need to make a payment
      AAD Member Login
      AAD Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Centers for Disease Control and Prevention
        Vital signs: current cigarette smoking among adults aged ≥18 years–United States, 2005-2010.
        MMWR Morb Mortal Wkly Rep. 2011; 60: 1207-1212
        • Doll R.
        • Peto R.
        • Boreham J.
        • Sutherland I.
        Mortality in relation to smoking: 50 years' observations on male British doctors.
        BMJ. 2004; 328: 1519
      1. Centers for Disease Control and Prevention. 2010 Surgeon General's report–how tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease. September 21, 2011. Available from: URL:http://www.surgeongeneral.gov/library/tobaccosmoke/report/index.html. Accessed December 10, 2011.

        • Rees T.D.
        • Liverett D.M.
        • Guy C.L.
        The effect of cigarette smoking on skin-flap survival in the face lift patient.
        Plast Reconstr Surg. 1984; 73: 911-915
        • Riefkohl R.
        • Wolfe J.A.
        • Cox E.B.
        • McCarty Jr., K.S.
        Association between cutaneous occlusive vascular disease, cigarette smoking, and skin slough after rhytidectomy.
        Plast Reconstr Surg. 1986; 77: 592-595
        • Manassa E.H.
        • Hertl C.H.
        • Olbrisch R.R.
        Wound healing problems in smokers and nonsmokers after 132 abdominoplasties.
        Plast Reconstr Surg. 2003; 111: 2082-2089
        • Akoz T.
        • Akan M.
        • Yildirim S.
        If you continue to smoke, we may have a problem: smoking's effects on plastic surgery.
        Aesthetic Plast Surg. 2002; 26: 477-482
        • Bikhchandani J.
        • Varma S.K.
        • Henderson H.P.
        Is it justified to refuse breast reduction to smokers?.
        J Plast Reconstr Aesthet Surg. 2007; 60: 1050-1054
        • Chan L.K.
        • Withey S.
        • Butler P.E.
        Smoking and wound healing problems in reduction mammaplasty: is the introduction of urine nicotine testing justified?.
        Ann Plast Surg. 2006; 56: 111-115
        • Henningfield J.E.L.
        • Edythe D.
        • Pogun S.
        Nicotine psychopharmacology (handbook of experimental pharmacology). March 16, 2009.
        1st ed. Springer, Los Angeles2009 (pp. 48-9)
        • Mosely L.H.
        • Finseth F.
        • Goody M.
        Nicotine and its effect on wound healing.
        Plast Reconstr Surg. 1978; 61: 570-575
        • Silverstein P.
        Smoking and wound healing.
        Am J Med. 1992; 93: 22S-24S
        • Jensen J.A.
        • Goodson W.H.
        • Hopf H.W.
        • Hunt T.K.
        Cigarette smoking decreases tissue oxygen.
        Arch Surg. 1991; 126: 1131-1134
        • Wennmalm A.
        • Alster P.
        Nicotine inhibits vascular prostacyclin but not platelet thromboxane formation.
        Gen Pharmacol. 1983; 14: 189-191
        • Kaufman T.
        • Eichenlaub E.H.
        • Levin M.
        • Hurwitz D.J.
        • Klain M.
        Tobacco smoking: impairment of experimental flap survival.
        Ann Plast Surg. 1984; 13: 468-472
        • Forrest C.R.
        • Pang C.Y.
        • Lindsay W.K.
        Dose and time effects of nicotine treatment on the capillary blood flow and viability of random pattern skin flaps in the rat.
        Br J Plast Surg. 1987; 40: 295-299
        • Forrest C.R.
        • Pang C.Y.
        • Lindsay W.K.
        Pathogenesis of ischemic necrosis in random-pattern skin flaps induced by long-term low-dose nicotine treatment in the rat.
        Plast Reconstr Surg. 1991; 87: 518-528
        • Eroglu L.
        • Orak I.
        • Turhan Haktanir N.
        Effect of short-term use of oral smokeless tobacco on random-pattern skin flap survival in rats.
        Scand J Plast Reconstr Surg Hand Surg. 2005; 39: 272-276
        • van Adrichem L.N.
        • Hoegen R.
        • Hovius S.E.
        • Kort W.J.
        • van Strik R.
        • Vuzevski V.D.
        • van der Meulen J.C.
        The effect of cigarette smoking on the survival of free vascularized and pedicled epigastric flaps in the rat.
        Plast Reconstr Surg. 1996; 97: 86-96
        • Su Y.
        • Cao W.
        • Han Z.
        • Block E.R.
        Cigarette smoke extract inhibits angiogenesis of pulmonary artery endothelial cells: the role of calpain.
        Am J Physiol Lung Cell Mol Physiol. 2004; 287: L794-L800
        • Ma L.
        • Chow J.Y.
        • Liu E.S.
        • Cho C.H.
        Cigarette smoke and its extract delays ulcer healing and reduces nitric oxide synthase activity and angiogenesis in rat stomach.
        Clin Exp Pharmacol Physiol. 1999; 26: 828-829
        • Michaud S.E.
        • Menard C.
        • Guy L.G.
        • Gennaro G.
        • Rivard A.
        Inhibition of hypoxia-induced angiogenesis by cigarette smoke exposure: impairment of the HIF-1alpha/VEGF pathway.
        FASEB J. 2003; 17: 1150-1152
        • Sorensen L.T.
        • Toft B.G.
        • Rygaard J.
        • Ladelund S.
        • Paddon M.
        • James T.
        • et al.
        Effect of smoking, smoking cessation, and nicotine patch on wound dimension, vitamin C, and systemic markers of collagen metabolism.
        Surgery. 2010; 148: 982-990
        • Sorensen L.T.
        • Jorgensen L.N.
        • Zillmer R.
        • Vange J.
        • Hemmingsen U.
        • Gottrup F.
        Transdermal nicotine patch enhances type I collagen synthesis in abstinent smokers.
        Wound Repair Regen. 2006; 14: 247-251
        • Campos J.H.
        • Gomes H.C.
        • dos-Santos W.L.
        • Cardeal M.
        • Ferreira L.M.
        Effect of nicotine treatment and withdrawal on random-pattern skin flaps in rats.
        Exp Toxicol Pathol. 2008; 60: 449-452
        • Mills C.M.
        • Srivastava E.D.
        • Harvey I.M.
        • Swift G.L.
        • Newcombe R.G.
        • Holt P.J.
        • Rhodes J.
        Smoking habits in psoriasis: a case-control study.
        Br J Dermatol. 1992; 127: 18-21
        • Naldi L.
        • Chatenoud L.
        • Linder D.
        • Belloni Fortina A.
        • Peserico A.
        • Virgili A.R.
        • et al.
        Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: results from an Italian case-control study.
        J Invest Dermatol. 2005; 125: 61-67
        • Naldi L.
        Cigarette smoking and psoriasis.
        Clin Dermatol. 1998; 16: 571-574
        • Herron M.D.
        • Hinckley M.
        • Hoffman M.S.
        • Papenfuss J.
        • Hansen C.B.
        • Callis K.P.
        • Krueger G.G.
        Impact of obesity and smoking on psoriasis presentation and management.
        Arch Dermatol. 2005; 141: 1527-1534
        • Bo K.
        • Thoresen M.
        • Dalgard F.
        Smokers report more psoriasis, but not atopic dermatitis or hand eczema: results from a Norwegian population survey among adults.
        Dermatology. 2008; 216: 40-45
        • Lebwhol M.
        • Callen J.P.
        Obesity, smoking, and psoriasis.
        JAMA. 2006; 295: 208-210
        • O'Doherty C.J.
        • MacIntyre C.
        Palmoplantar pustulosis and smoking.
        Br Med J (Clin Res Ed). 1985; 291: 861-864
        • Michaelsson G.
        • Gustafsson K.
        • Hagforsen E.
        The psoriasis variant palmoplantar pustulosis can be improved after cessation of smoking.
        J Am Acad Dermatol. 2006; 54: 737-738
        • Hagforsen E.
        • Awder M.
        • Lefvert A.K.
        • Nordlind K.
        • Michaelsson G.
        Palmoplantar pustulosis: an autoimmune disease precipitated by smoking?.
        Acta Derm Venereol. 2002; 82: 341-346
        • Miot H.A.
        • Miot L.D.
        • Lopes P.S.
        • Haddad G.R.
        • Marques S.A.
        Association between palmoplantar pustulosis and cigarette smoking in Brazil: a case-control study.
        J Eur Acad Dermatol Venereol. 2009; 23: 1173-1177
        • Konig A.
        • Lehmann C.
        • Rompel R.
        • Happle R.
        Cigarette smoking as a triggering factor of hidradenitis suppurativa.
        Dermatology. 1999; 198: 261-264
        • Revuz J.E.
        • Canoui-Poitrine F.
        • Wolkenstein P.
        • Viallette C.
        • Gabison G.
        • Pouget F.
        • et al.
        Prevalence and factors associated with hidradenitis suppurativa: results from two case-control studies.
        J Am Acad Dermatol. 2008; 59: 596-601
        • Sartorius K.
        • Emtestam L.
        • Jemec G.B.
        • Lapins J.
        Objective scoring of hidradenitis suppurativa reflecting the role of tobacco smoking and obesity.
        Br J Dermatol. 2009; 161: 831-839
        • Costenbader K.H.
        • Karlson E.W.
        Cigarette smoking and systemic lupus erythematosus: a smoking gun?.
        Autoimmunity. 2005; 38: 541-547
        • Costenbader K.H.
        • Kim D.J.
        • Peerzada J.
        • Lockman S.
        • Nobles-Knight D.
        • Petri M.
        • Karlson E.W.
        Cigarette smoking and the risk of systemic lupus erythematosus: a meta-analysis.
        Arthritis Rheum. 2004; 50: 849-857
        • Ghaussy N.O.
        • Sibbitt Jr., W.
        • Bankhurst A.D.
        • Qualls C.R.
        Cigarette smoking and disease activity in systemic lupus erythematosus.
        J Rheumatol. 2003; 30: 1215-1221
        • Ghaussy N.O.
        • Sibbitt Jr., W.L.
        • Qualls C.R.
        Cigarette smoking, alcohol consumption, and the risk of systemic lupus erythematosus: a case-control study.
        J Rheumatol. 2001; 28: 2449-2453
        • Jewell M.L.
        • McCauliffe D.P.
        Patients with cutaneous lupus erythematosus who smoke are less responsive to antimalarial treatment.
        J Am Acad Dermatol. 2000; 42: 983-987
        • Rahman P.
        • Gladman D.D.
        • Urowitz M.B.
        Smoking interferes with efficacy of antimalarial therapy in cutaneous lupus.
        J Rheumatol. 1998; 25: 1716-1719
        • Solly S.
        Clinical lectures on paralysis.
        Lancet. 1856; ii: 641-643
        • Daniell H.W.
        Smoker's wrinkles: a study in the epidemiology of “crow's feet”.
        Ann Intern Med. 1971; 75: 873-880
        • Model D.
        Smoker's face: an underrated clinical sign?.
        Br Med J (Clin Res Ed). 1985; 291: 1760-1762
        • Frances C.
        • Boisnic S.
        • Hartmann D.J.
        • Dautzenberg B.
        • Branchet M.C.
        • Charpentier Y.L.
        • Robert L.
        Changes in the elastic tissue of the non-sun-exposed skin of cigarette smokers.
        Br J Dermatol. 1991; 125: 43-47
        • Guyuron B.
        • Rowe D.J.
        • Weinfeld A.B.
        • Eshraghi Y.
        • Fathi A.
        • Iamphongsai S.
        Factors contributing to the facial aging of identical twins.
        Plast Reconstr Surg. 2009; 123: 1321-1331
        • Placzek M.
        • Kerkmann U.
        • Bell S.
        • Koepke P.
        • Przybilla B.
        Tobacco smoke is phototoxic.
        Br J Dermatol. 2004; 150: 991-993
        • Jorgensen L.N.
        • Kallehave F.
        • Christensen E.
        • Siana J.E.
        • Gottrup F.
        Less collagen production in smokers.
        Surgery. 1998; 123: 450-455
        • Yin L.
        • Morita A.
        • Tsuji T.
        Alterations of extracellular matrix induced by tobacco smoke extract.
        Arch Dermatol Res. 2000; 292: 188-194
        • Wolf R.
        • Wolf D.
        • Ruocco V.
        Smoking and the skin, radically speaking.
        Clin Dermatol. 1998; 16: 633-639
        • Ghadially F.N.
        • Barton B.W.
        • Kerridge D.F.
        The etiology of keratoacanthoma.
        Cancer. 1963; 16: 603-611
        • Miot H.A.
        • Miot L.D.
        • da Costa A.L.
        • Matsuo C.Y.
        • Stolf H.O.
        • Marques M.E.
        Association between solitary keratoacanthoma and cigarette smoking: a case-control study.
        Dermatol Online J. 2006; 12: 2
        • El-Hakim I.E.
        • Uthman M.A.
        Squamous cell carcinoma and keratoacanthoma of the lower lip associated with "Goza" and "Shisha" smoking.
        Int J Dermatol. 1999; 38: 108-110
        • Rollison D.E.
        • Iannacone M.R.
        • Messina J.L.
        • Glass L.F.
        • Giuliano A.R.
        • Roetzheim R.G.
        • et al.
        Case-control study of smoking and non-melanoma skin cancer.
        Cancer Causes Control. 2012; 23: 245-254
        • Smith J.B.
        • Randle H.W.
        Giant basal cell carcinoma and cigarette smoking.
        Cutis. 2001; 67: 73-76
        • Wojno T.H.
        The association between cigarette smoking and basal cell carcinoma of the eyelids in women.
        Ophthal Plast Reconstr Surg. 1999; 15: 390-392
        • Corona R.
        • Dogliotti E.
        • D'Errico M.
        • Sera F.
        • Iavarone I.
        • Baliva G.
        • et al.
        Risk factors for basal cell carcinoma in a Mediterranean population: role of recreational sun exposure early in life.
        Arch Dermatol. 2001; 137: 1162-1168
        • Wahie S.
        • Lawrence C.M.
        Wound complications following diagnostic skin biopsies in dermatology inpatients.
        Arch Dermatol. 2007; 143: 1267-1271
        • Goldminz D.
        • Bennett R.G.
        Cigarette smoking and flap and full-thickness graft necrosis.
        Arch Dermatol. 1991; 127: 1012-1015
        • Little S.C.
        • Hughley B.B.
        • Park S.S.
        Complications with forehead flaps in nasal reconstruction.
        Laryngoscope. 2009; 119: 1093-1099
        • Myers M.
        Attempts to augment survival in skin flaps: mechanism of the delay phenomenon.
        in: Graff W. Myers M.B. Skin flaps. Little, Brown and Company, Boston1975
        • Odland R.M.
        • Kim P.
        • Nadler D.
        • Poole D.V.
        Nonsurgical delay of skin flaps: effect of a suture delay technique on blood flow and survival.
        Laryngoscope. 1995; 105: 523-528
        • Isik D.
        • Kiroglu F.
        • Isik Y.
        • Goktas U.
        • Atik B.
        Clinical outcomes of suture delay in forehead flap.
        J Craniofac Surg. 2012; 23: 75-77
        • Goldan O.
        • Garbov-Nardini G.
        • Regev E.
        • Orenstein A.
        • Winkler E.
        Late-onset infections and granuloma formation after facial polylactic acid (New-Fill) injections in women who are heavy smokers.
        Plast Reconstr Surg. 2008; 121: 336e-338e
        • Shiloah J.
        • Patters M.R.
        • Waring M.B.
        The prevalence of pathogenic periodontal microflora in healthy young adult smokers.
        J Periodontol. 2000; 71: 562-567
        • Naouri M.
        • Atlan M.
        • Perrodeau E.
        • Georgesco G.
        • Khallouf R.
        • Martin L.
        • Machet L.
        High-resolution ultrasound imaging to demonstrate and predict efficacy of carbon dioxide fractional resurfacing laser treatment.
        Dermatol Surg. 2011; 37: 596-603
        • Schwartz R.J.
        • Burns A.J.
        • Rohrich R.J.
        • Barton Jr., F.E.
        • Byrd H.S.
        Long-term assessment of CO2 facial laser resurfacing: aesthetic results and complications.
        Plast Reconstr Surg. 1999; 103: 592-601
        • Hsu T.S.
        • Zelickson B.
        • Dover J.S.
        • Kilmer S.
        • Burns J.
        • Hruza G.
        • et al.
        Multicenter study of the safety and efficacy of a 585 nm pulsed-dye laser for the nonablative treatment of facial rhytides.
        Dermatol Surg. 2005; 31: 1-9
        • Klein D.R.
        • Little J.H.
        Laryngeal edema as a complication of chemical peel.
        Plast Reconstr Surg. 1983; 71: 419-420
        • Krueger J.K.
        • Rohrich R.J.
        Clearing the smoke: the scientific rationale for tobacco abstention with plastic surgery.
        Plast Reconstr Surg. 2001; 108: 1063-1077
        • Benowitz N.L.
        • Lake T.
        • Keller K.H.
        • Lee B.L.
        Prolonged absorption with development of tolerance to toxic effects after cutaneous exposure to nicotine.
        Clin Pharmacol Ther. 1987; 42: 119-120
        • Rohrich R.J.
        • Coberly D.M.
        • Krueger J.K.
        • Brown S.A.
        Planning elective operations on patients who smoke: survey of North American plastic surgeons.
        Plast Reconstr Surg. 2002; 109: 350-357
        • Chang D.W.
        • Reece G.P.
        • Wang B.
        • Robb G.L.
        • Miller M.J.
        • Evans G.R.
        • et al.
        Effect of smoking on complications in patients undergoing free TRAM flap breast reconstruction.
        Plast Reconstr Surg. 2000; 105: 2374-2380
        • Mangat D.S.
        • Tansavatdi K.
        • Garlich P.
        Current chemical peels and other resurfacing techniques.
        Facial Plast Surg. 2011; 27: 35-49
        • Cook J.L.
        • Perone J.B.
        A prospective evaluation of the incidence of complications associated with Mohs micrographic surgery.
        Arch Dermatol. 2003; 139: 143-152
        • Starling III, J.
        • Thosani M.K.
        • Coldiron B.M.
        Determining the safety of office-based surgery: what 10 years of Florida data and 6 years of Alabama data reveal.
        Dermatol Surg. 2012; 38: 171-177
        • Gariti P.
        • Rosenthal D.I.
        • Lindell K.
        • Hansen-Flaschen J.
        • Shrager J.
        • Lipkin C.
        • et al.
        Validating a dipstick method for detecting recent smoking.
        Cancer Epidemiol Biomarkers Prev. 2002; 11: 1123-1125