Economopoulos, Konstantinos P

Theocharidis, Vasileios

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 Smoking cessation prior to elective plastic surgery: why, whenand how?  (Article begins on next page)The Harvard community has made this article openly available.Please share how this access benefits you. Your story matters.Citation Theocharidis, Vasileios, and Konstantinos P Economopoulos.2014. “Smoking cessation prior to elective plastic surgery: why,when and how?” Tobacco Induced Diseases 12 (Suppl 1): A18.doi:10.1186/1617-9625-12-S1-A18.http://dx.doi.org/10.1186/1617-9625-12-S1-A18.Published Version doi:10.1186/1617-9625-12-S1-A18Accessed February 16, 2015 4:13:02 PM ESTCitable Link http://nrs.harvard.edu/urn-3:HUL.InstRepos:12717531Terms of Use This article was downloaded from Harvard University's DASHrepository, and is made available under the terms and conditionsapplicable to Other Posted Material, as set forth athttp://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAAMEETING ABSTRACT Open AccessSmoking cessation prior to elective plasticsurgery: why, when and how?Vasileios Theocharidis1,2*, Konstantinos P Economopoulos1,3From 11th Annual Conference of the International Society for the Prevention of Tobacco Induced Diseases(ISPTID)Athens, Greece. 9-11 December 2013BackgroundTobacco is a serious nuisance in plastic surgery, mainlythrough the effects of its inhaled constituents on woundhealing physiology. While there are thousands of chemi-cal compounds in the inhaled smoke, the most promi-nent ones are nicotine, carbon monoxide and hydrogencyanide, which are partially responsible for impairedwound healing through decreased oxygen delivery andutilization, and deranged collagen deposition [1]. Ouraim is to summarize the existing literature on the effectsof smoking in various plastic surgical procedures, and onthe correct timing and available methods of preoperativesmoking cessation.Materials and methodsA literature review of PubMed was performed. The inclu-sion criteria were: articles on the effects of smoking onwound healing, plastic surgery and hand surgery, on thetiming of preoperative smoking cessation and on methodsof smoking cessation. The search terms used in combina-tions were “smoking”, “plastic surgery”, “wound healing”,“hand surgery”, “smoking cessation”.ResultsIn facelift procedures, skin slough is an important compli-cation and there is a strong association between smokingand higher skin slough rates [2]. A similar relationship canbe identified in abdominoplasty, as smokers suffer from ahigher percentage of wound healing complications [3].Complications like T-junction necrosis and infectionswere also higher in smokers who underwent breast reduc-tion [4]. Regarding breast reconstruction, two studiesshowed higher rates of reconstructive failure and overallcomplications in smokers [5]. However, no significantdifference was found regarding flap loss and vascularthrombosis between smokers and non-smokers [6]. Inmicrosurgical free flap transfer, the relationship visitedabove is prevalent, with higher wound healing-relatedcomplication rates for smokers. [7]. In hand surgery, it hasbeen shown that smoking post-replantation decreases digi-tal blood flow significantly [8]. A meta-analysis showed thedetrimental effect of smoking on the success rate of digitreplantation (61.1% in smokers vs. 96.7% in non-smokers)[9]. While there is no consensus regarding the optimalsmoke-free period preoperatively, many authors agree that4 weeks are capable of reducing the rates of smoking-related complications satisfactorily. Some authors supportthe use of cotinine measurement, as patient history canprove notoriously inaccurate [10]. In order to improve thelow cessation rate achieved by no intervention (about 1 in8) [11], nicotine replacement therapy and medication canbe used effectively [12].ConclusionsSmoking is an independent risk factor for wound healingcomplications, but not for free flap loss. Smokers whoare candidates for plastic surgery should cease smokingfor an adequate amount of time preoperatively. Nicotinereplacement therapy and medication are effective inassisting their smoking cessation efforts.Authors’ details1Society of Junior Doctors, Athens, 15123, Greece.2Medical school, Nationaland Kapodistrian University of Athens, Athens, 115 27, Greece.3Departmentof Surgery, Massachusetts General Hospital, Harvard Medical School, Boston,Massachusetts, 02114, USA.Published: 6 June 2014References1. Silverstein P: Smoking and wound healing. Am J Med 1992, 93(1a):22-24.* Correspondence: billth1@windowslive.com1Society of Junior Doctors, Athens, 15123, GreeceFull list of author information is available at the end of the articleTheocharidis and Economopoulos Tobacco Induced Diseases 2014, 12(Suppl 1):A18http://www.tobaccoinduceddiseases.com/content/12/S1/A18© 2014 Theocharidis and Economopoulos; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms ofthe Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution,and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedicationwaiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.2. Rees TD, Liverett DM, Guy CL: The Effect of Cigarette Smoking on Skin-Flap Survival in the Face Lift Patient. Plastic and Reconstructive Surgery1984, 73(6):911-915.3. Manassa EH, Hertl CH, Olbrisch RR: Wound Healing Problems in Smokersand Nonsmokers after 132 Abdominoplasties. Plastic and ReconstructiveSurgery 2003, 111(6):2082-2087.4. Bikhchandani J, Varma SK, Henderson HP: Is it justified to refuse breastreduction to smokers? Journal of plastic, reconstructive & aestheticsurgery. JPRAS 2007, 60(9):1050-1054.5. McCarthy CM, Mehrara BJ, Riedel E, Davidge K, Hinson A, Disa JJ,Cordeiro PG, Pusic AL: Predicting complications following expander/implant breast reconstruction: an outcomes analysis based onpreoperative clinical risk. Plast Reconstr Surg 2008, 121(6):1886-92.6. Chang DW, Reece GP, Wang B, Robb GL, Miller MJ, Evans GR, Langstein HN,Kroll SS: Effect of smoking on complications in patients undergoing freeTRAM flap breast reconstruction. Plast Reconstr Surg 2000, 105(7):2374-80.7. Chang LD, Buncke G, Slezak S, Buncke HJ: Cigarette smoking, plasticsurgery, and microsurgery. J Reconstr Microsurg 1996, 12(7):467-74.8. Van Adrichem LN, Hovius SE, van Strik R, van der Meulen JC: The acuteeffect of cigarette smoking on the microcirculation of a replanted digit.J Hand Surg Am 1992, 17(2):230-4.9. Dec W: A meta-analysis of success rates for digit replantation. Tech HandUp Extrem Surg 2006, 10(3):124-9.10. Payne CE, Southern SJ: Urinary point-of-care test for smoking in the pre-operative assessment of patients undergoing elective plastic surgery.J Plast Reconstr Aesthet Surg 2006, 59(11):1156-61.11. Rinker B: The evils of nicotine: an evidence-based guide to smoking andplastic surgery. Ann Plast Surg 2013, 70(5):599-605.12. Mahvan T, Namdar R, Voorhees K, Smith PC, Ackerman W: Clinical Inquiry:which smoking cessation interventions work best? J Fam Pract 2011,60(7):430-1.doi:10.1186/1617-9625-12-S1-A18Cite this article as: Theocharidis and Economopoulos: Smoking cessationprior to elective plastic surgery: why, when and how? Tobacco InducedDiseases 2014 12(Suppl 1):A18.Submit your next manuscript to BioMed Centraland take full advantage of: • Convenient online submission• Thorough peer review• No space constraints or color ﬁgure charges• Immediate publication on acceptance• Inclusion in PubMed, CAS, Scopus and Google Scholar• Research which is freely available for redistributionSubmit your manuscript at www.biomedcentral.com/submitTheocharidis and Economopoulos Tobacco Induced Diseases 2014, 12(Suppl 1):A18http://www.tobaccoinduceddiseases.com/content/12/S1/A18Page 2 of 2

Smoking cessation prior to elective plastic surgery: why, when and how?

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Smoking cessation prior to elective plastic surgery: why, when and how?

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