Crucial aspects of smoking in wound healing after breast reduction surgery.
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- (2117 ng/cc) and especially postoperatively (485 ng/cc) compared to smokers with regular woundhealing (1614 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 healing in patients undergoing breast reduction.
Hospital Rudolfstiftung, Department of Plastic and Reconstructive Surgery, Juchgasse 25, 1010 Vienna, Vienna, Austria. rudolf.bartsch@wienkav.at
Rudolf Heinrich
RH
Bartsch
Gabriel
G
Weiss
Thomas
T
Kästenbauer
Kurt
K
Patocka
Maria
M
Deutinger
Björn Dirk
BD
Krapohl
Heike Christina
HC
Benditte-Klepetko
D000328:Adult; D015415:Biomarkers / Q000652:urine; D003367:Cotinine / Q000652:urine; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008875:Middle Aged; D011446:Prospective Studies; D012907:Smoking / Q000009:adverse effects / Q000503:physiopathology*; D013530:Surgical Wound Infection; D014945:Wound Healing
D015415:Biomarkers; D003367:Cotinine