Crucial aspects of smoking in wound healing after breast reduction surgery☆
Received 16 March 2006; accepted 28 August 2006. published online 12 March 2007.
Summary
Background
The aim of this study was to investigate the influence of cigarette smoking on wound-healing in patients undergoing breast reduction.
Methods
In our prospective study, 50 patients (25 smokers, 25 nonsmokers) scheduled for breast reduction have been evaluated. Urine cotinine levels were measured to analyse perioperative smoking habits. Urine samples were taken preoperatively and on the fourth postoperative day. Cotinine as a metabolite of nicotine allows precise evaluation of nicotine exposure. To assess the progress of woundhealing we classified secreting, instable, inflamed or necrotic wound conditions, which required a dressing after the tenth postoperative day as impaired wound healing. For statistical analysis non-parametrical tests for independent and dependent data were used.
Results
Ten of 25 smokers presented impaired wound healing compared to 4 of 25 nonsmokers. The median cotinine level of smokers was 1964 (783/3963)ng/cc preoperatively and 432 (148/1695)ng/cc postoperatively. Nonsmokers had a preoperative cotinine level of 18 (7/37)ng/cc and 15 (4/34)ng/cc postoperatively. Smokers who developed impaired wound-healing showed higher levels of cotinine pre- (2117ng/cc) and especially postoperatively (485ng/cc) compared to smokers with regular woundhealing (1614ng/cc and 389ng/cc). Both differences in cotinine levels were statistically significant (p=0.03 and p=0.02).
Conclusions
The data of the present study confirm the negative effect of smoking on wound healing in patients undergoing breast reduction.
aHospital Rudolfstiftung, Department of Plastic and Reconstructive Surgery, Juchgasse 25, 1010 Vienna, Vienna, Austria
bDepartment for Plastic and Reconstructive Surgery, Hietzing Hospital Wolkersbergenstrasse 1, 1130 Vienna, Austria
cL. Boltzman Institute of Metabolic Diseases and Nutrition, Hietzing Hospital, Wolkersbergenstrasse 1, 1130 Vienna, Austria
dDepartment of Pulmonology, Hietzing Hospital, Wolkersbergenstrasse 1, 1130 Vienna, Austria
Corresponding author. Hospital Rudolfstiftung, Department of Plastic and Reconstructive Surgery, Juchgasse 25, 1010 Vienna, Vienna, Austria. Tel.: +43 699 11 222 000; fax: +43 1 80 110 2719.
☆ This paper was presented on the 42nd Meeting of the Austrian Society of Plastic, Aesthetic and Reconstructive Surgeons, Innsbruck, Austria, 2004 (2nd Prize of the Austrian society of Plastic, Aesthetic and Reconstructive Surgery.)
ABSTRACT