Smoking and its effect on scar healing

Abstract

Scar formation is influenced by several factors such as wound infection, tension, wound depth and anatomical localization. Hypertrophic scarring is often the result of an imbalance in the wound and scar healing process. The exact underlying pathophysiological mechanism remains unclear. Smoking has a higher risk of postoperative complications probably due to a diminished macrophage induction. Following our clinical impression that smokers without postoperative wound infections show esthetically better scars, we evaluated the scars after a reduction mammaplasty in smoking and nonsmoking patients in a prospective clinical trial. Between July 2006 and September 2007, 13 smokers and 30 non smokers with a reduction mammaplasty were included. They were recruited from Viecuri Medical Centre and Atrium Medical Centre in the Netherlands after written consent. Surgical data and data of the patients' condition were collected. Follow-up for erythema values of the scars was done with a colorimeter (The Minolta CR-300, Minolta Camera Co., Ltd., Osaka Japan) at 1, 3, 6 and 9 months postoperatively on four standardized postsurgical sites. ANOVA and Chi-square test were used for statistical analysis. In the smoking group, the scars were significantly less red compared to the nonsmoking group. No significant differences were found in BMI, resection weight and drain production between both groups. Although smoking is certainly not recommended as a preventive therapy to influence scar healing, this study confirms our assumption that smokers tend to have faster and less erythemateous scar healing to nonsmokers. Further research is needed to understand the mechanism of the effect of smoking on scars.

Fig. 1

Redness measured postoperatively with the colorimeter at the lateral part of the scar. Significant difference in redness after 1 month (p < 0.01) and after 9 months (p < 0.05)

Fig. 2

Redness measured postoperatively with the colorimeter at the medial part of the scar. Significant difference after 3 months (p < 0.005). After 6 months, there was a slight difference in redness (p = 0.066)

Fig. 3

Redness measured postoperatively with the colorimeter at the topmost point of the nipple. Significant difference after 1 month (p < 0.01) and after 9 months (p < 0.05)

Fig. 4

Redness measured postoperatively with the colorimeter at the center of the inframammary fold. No significant differences were found in the scar of the nipple. The differences in redness are p = 0.116 after 1 month, p = 0.209 after 3 months, p = 0.107 after 6 months and p = 0.575 after 9 months