Crucial aspects of smoking in wound heating after breast reduction surgery

Background: The aim of this study was to investigate the influence of cigarette smoking on wound-heating 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 heating. For statistical analysis non-parametrical tests for independent and dependent data were used. Results: Ten of 25 smokers presented impaired wound heating 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-heating showed higher levels of cotinine pre- (2117 ng/cc) and especially postoperatively (485 ng/cc) compared to smokers with regular woundhealing (11614 ng/cc and 389 ng/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 heating in patients undergoing breast reduction. (c) 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.