Smoking and Wound Healing

Most smokers are aware of the long term risks involved with tobacco use. Despite doctor’s warning against smoking before surgery, some patients continue to smoke before and after their surgery. Due to poor surgical outcomes and increased mortality and morbidity, some surgeons refuse to operate on smokers.

Continuing to smoke before and after surgery is equal to playing Russian roulette with your life. Patients who smoke during the last 24 hours before surgery have twenty times more episodes of inadequate oxygen supply to the heart while under general anesthesia than the non-smokers. This means that a smoker’s chanceof a heart attack due to smoking alone (not including smoking and medical history) is at least twenty times higher than in non-smokers.

As a smoker, or if you are exposed to second hand smoke, you can potentially develop complications such as poor wound healing, infection and bad scarring after surgery. Wounds will not heal without a good blood supply and circulating oxygen. Smoking reduces the blood flow to the wound by constricting small blood vessels; it reduces the ability of hemoglobin to move oxygen to the wound; and it reduces the amount of oxygen delivered to the wound. 

Multiple studies have shown that smoking delays bone, ligament and soft tissue healing. The average time until complete bone healing is approximately two months longer in smokers. Failure of rotator cuff repairs in smokers is often due to poor tendon-to-bone healing. However, if you start nicotine replacement therapy at least four weeks before and eight weeks after surgery, you can halve your risk of poor wound healing.

Quitting Smoking Before Surgery

In order to heal well after surgery, you should quit smoking.

• If you are unable to quit smoking cold turkey, start nicotine replacement therapy as soon as possible. You can buy nicotine gum, nicotine lozenges and nicotine patches at your local pharmacy. Additional smoking cessation medications need a prescription from your primary care physician.

• Quitting smoking at least four weeks before and for eight weeks after surgery will help surgical wounds heal with markedly decreased risk of post-surgical complications.

• Wound dressings, clothing, furniture and wallpaper absorb cigarette smoke. If you live in a home where there is smoke (secondary hand smoke), your wound healing may potentially be compromised.

+Dr. Kayvon Izadi