番茄社区

Smokers have an increased risk for complications following plastic surgery, and users of e-cigarettes and other vaping products containing nicotine may face a similar risk, researchers say.

Cigarettes smokers are commonly told to stop smoking during the weeks prior to undergoing cosmetic surgical procedures, and it is probably a good idea for e-cigarette users to refrain from vaping as well, wrote , of Mount Sinai Medical Center and , of Albert Einstein College of Medicine, both in New York City.

"Refraining from (e-cigarette) use four weeks before surgery is a prudent course of action despite the fact that it has yet to be determined whether the effects are similar to those of traditional cigarettes," Taub and Matarasso wrote in the December issue of published online Nov. 28.

In an interview with 番茄社区, Taub said that while e-cigarettes are generally recognized as being much safer than traditional cigarettes, they could potentially have similar effects on vasoconstriction.

Cigarette smokers have an increased incidence of skin flap complications following plastic surgery, which is thought to be related to nicotine-induced restrictions in blood flow, Taub said. Good perfusion of skin flaps is critical to rapid healing with minimal scarring.

"We really need studies that examine how e-cigarette use impacts wound healing and tissue perfusion," he said. "In the meantime, I would like to see plastic surgeons ask their patients about vaping as well as cigarette smoking."

Taub added that in the absence of good data, it seems reasonable to advise patients to stop using e-cigarettes prior to undergoing plastic surgery procedures in the same way that smokers are told to abstain.

While no previous studies have examined the impact of vaping on plastic surgery outcomes, nicotine's vasoconstricting effect is well characterized in the literature. Nicotine-induced vasoconstriction of the myocardium has been shown in several studies to aggravate hypoperfusion in patients with cardiac artery disease.

In a 2012 , smoking was found to impair wound healing. Smoking temporarily decreases tissue oxygenation and aerobic metabolism and diminishes inflammatory response via weakened chemotaxis, reduced migration, impaired bacterial killing by inflammatory cells, and subnormal release of proteolytic enzymes and inhibitors, the authors indicated. The included studies also showed that collagen synthesis and deposition were down-regulated.

"These effects are likely related to the combination of nicotine and any additional harmful products in cigarette smoke," Taub and Matarasso wrote. "With cessation of smoking, tissue oxygenation and metabolism rapidly improve. The inflammatory response is reversed in part within four weeks, whereas the proliferative response remains impaired."

Taub and Matarasso noted that e-cigarettes, like traditional cigarettes, deliver varying doses of nicotine, ranging from 1.8% to as high 10%, and that many contain other, potentially harmful, compounds.

They concluded that even though e-cigarettes appear to be safer than traditional cigarettes, the uncertainty about their overall safety warrants caution, especially in the surgical setting.

"Based on our current knowledge, it seems reasonable to advise plastic surgery candidates to cease e-cigarette use in a manner similar to what is advised with traditional nicotine inhalation compounds," they wrote. "More definitive research might elucidate the effects of vaporized nicotine on the survival of skin and soft-tissue flaps, as they most intimately relate to the safe practice of plastic surgery."