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Review
. 2022 Nov 1;48(11):1171-1175.
doi: 10.1097/DSS.0000000000003547. Epub 2022 Jul 20.

Is There a Smoking Gun for Nicotine? A Review of the Role of Nicotine in Dermatologic Surgery

Mauricio F Jin  1 , Elliott H Campbell  2 , Ally-Khan Somani  3
Affiliations
Review

Is There a Smoking Gun for Nicotine? A Review of the Role of Nicotine in Dermatologic Surgery

Mauricio F Jin et al. Dermatol Surg. .

Abstract

Background: Dermatologic surgeons are faced with a dilemma when counseling actively smoking patients who require dermatologic surgery: recommend total cessation of all nicotine that is associated with extremely high rates of cessation failure or recommend nicotine replacement therapy (NRT).

Objective: To determine the safety of NRT in dermatologic surgery.

Materials and methods: PubMed was queried: [(nicotine OR electronic cigarettes) AND (flap OR wound healing)].

Results: Smoking tobacco is detrimental to wound healing, supported by ample evidence (1A). Perioperative smoking cessation reduces risk (1B). Basic science demonstrates both a benefit and detriment of nicotine depending on the factor studied (2A). Human studies suggest no detrimental effect of nicotine on perioperative complications (1B). Nicotine may be detrimental to flaps, but evidence is limited to basic science (2A).

Conclusion: Dermatologists should consider recommending nicotine replacement for smokers in the perioperative period. Evidence is lacking to determine safety in flaps. It is presumed based on animal studies that nicotine has a negative effect on flaps; however, it is likely less than tobacco. Weighing the risk of cessation failure without nicotine replacement versus nicotine replacement after flap is challenging. Electronic cigarettes should be discouraged as a means of NRT.

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References

    1. Kuri M, Nakagawa M, Tanaka H, Hasuo S, et al. Determination of the duration of preoperative smoking cessation to improve wound healing after head and neck surgery. Anesthesiology. 2005;102:892–6.
    1. Rossi M, Pistelli F, Pesce M, Aquilini F, et al. Impact of long-term exposure to cigarette smoking on skin microvascular function. Microvasc Res. 2014;93:46–51.
    1. Jorgensen LN, Kallehave F, Christensen E, Siana JE, et al. Less collagen production in smokers. Surgery. 1998;123:450–5.
    1. Sørensen LT. Wound healing and infection in surgery. The clinical impact of smoking and smoking cessation: a systematic review and meta-analysis. Arch Surg. 2012;147:373–83.
    1. Petschke FT, Engelhardt TO, Ulmer H, Piza-Katzer H. Effect of cigarette smoking on skin perfusion of the hand [in German]. Chirurg. 2006;77:1022–6.

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