The ill effects of smoking on the body are well known, yet millions of people continue to smoke. This includes roughly 4.5 million adults over age 65. Quitting smoking has become so important that Medicare recently announced that they will be providing counseling for any of its recipients who are trying to “kick the habit.”
The association between cigarette smoking and delayed wound healing is well recognized. The documented effects of the toxic components of cigarette smoke–particularly nicotine, carbon monoxide, and hydrogen cyanide–suggest potential mechanisms by which smoking may undermine expeditious wound repair. Nicotine is a vasoconstrictor that reduces nutritional blood flow to the skin, resulting in tissue ischemia and impaired healing of injured tissue. Nicotine also increases platelet adhesiveness, raising the risk of thrombotic microvascular occlusion and tissue ischemia. In addition, proliferation of the body’s wound healing cellular cascade (i.e. red blood cells, fibroblasts, and macrophages) is reduced by nicotine. Carbon monoxide diminishes oxygen transport and metabolism, whereas hydrogen cyanide inhibits the enzyme systems necessary for oxidative metabolism and oxygen transport at the cellular level. Slower healing has been observed clinically in smokers with wounds resulting from trauma, disease, or surgical procedures. The reduced capacity for wound repair is a particular concern in patients undergoing plastic or reconstructive surgery. Compared with nonsmokers, smokers have a higher incidence of unsatisfactory healing after face-lift surgery, as well as a greater degree of complications following breast surgery. Smokers should be advised to stop smoking prior to elective surgery or when recovering from wounds resulting from trauma, disease, or surgery.