To Örebro University

Introduction: Nicotine consumption is linked to higher perioperative complications. The cellular damage secondary to smoking is due to cellular dysfunction and thrombogenesis following free radical release, tissue hypoxia, microvascular injury, and inhibition of immune cell function by oxidative stress. This has an impact on wound healing as a whole, while increasing risk of infection and wound dehiscence.

Method: A review of the literature was conducted to summarize all studies focusing nicotine-complications in Plastic and Hand surgery. Of 2,186 articles, retrieved from PubMed, Embase and Web of Science databases, 364 publications were included following a blinded parallel screening as per PRISMA.

Result: Numerous peri-operative complications have been attributed to smoking, from undesirable aesthetic outcomes to life threatening sepsis. Some previous studies have illustrated a few of nicotine’s physiological effects as reversible, through a smoking cessation ranging from 3 to 8 weeks, or even longer, while others seem persistent. Available literature has found a correspondence between the amount of nicotine consumption and complication rates. Both pre- and postoperative nicotine cessation has been proven to have favourable outcome.

Discussion: Nicotine abuse is linked to higher complication rates following Plastic and Hand Surgery, according to the published literature. Nicotine consumers are a high-risk patient group that needt o be stratified, evaluated for peri-operative morbidities, and provided risk-specific care and follow-up.

It is important to understand the pathophysiological mechanisms behind the negative effects of nicotine on postoperative recovery. A standardized pre- and postoperative nicotine detox routine should be established to minimize the rate of postoperative complications.