title: Smoking and plastic surgery, part I. Pathophysiological aspects: update and proposed recommendations.
abstract: OBJECTIVE
  Smoking patients undergoing a plastic surgery intervention are exposed to increased risk of perioperative and postoperative complications. It seemed useful to us to establish an update about the negative impact of smoking, especially on wound healing, and also about the indisputable benefits of quitting. We wish to propose a minimum time lapse of withdrawal in the preoperative and postoperative period in order to reduce the risks and maximize the results of the intervention.
  
  
  METHODS
  A literature review of documents from 1972 to 2014 was carried out by searching five different databases (Medline, PubMed Central, Cochrane library, Pascal and Web of Science).
  
  
  RESULTS
  Cigarette smoke has a diffuse and multifactorial impact in the body. Hypoxia, tissue ischemia and immune disorders induced by tobacco consumption cause alterations of the healing process. Some of these effects are reversible by quitting. Data from the literature recommend a preoperative smoking cessation period lasting between 3 and 8 weeks and up until 4 weeks postoperatively. Use of nicotine replacement therapies doubles the abstinence rate in the short term. When a patient is heavily dependent, the surgeon should be helped by a tobacco specialist.
  
  
  CONCLUSIONS
  Total smoking cessation of 4 weeks preoperatively and lasting until primary healing of the operative site (2 weeks) appears to optimize surgical conditions without heightening anesthetic risk. Tobacco withdrawal assistance, both human and drug-based, is highly recommended.
authors.affiliation: Service de chirurgie orthopédique, traumatologique, plastique, reconstructrice et assistance main, CHU Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon cedex, France.
authors.forename: I
authors.initials: I
authors.lastname: Pluvy
authors.affiliation: Service de chirurgie plastique, reconstructrice et des brûlés, CHU Rangueil, 1, avenue du Pr Jean Poulhès, TSA 50032, 31059 Toulouse cedex, France.
authors.forename: I
authors.initials: I
authors.lastname: Garrido
authors.affiliation: Service de chirurgie orthopédique, traumatologique, plastique, reconstructrice et assistance main, CHU Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon cedex, France.
authors.forename: J
authors.initials: J
authors.lastname: Pauchot
authors.affiliation: Service de chirurgie plastique, reconstructrice et des brûlés, CHU Rangueil, 1, avenue du Pr Jean Poulhès, TSA 50032, 31059 Toulouse cedex, France.
authors.forename: J
authors.initials: J
authors.lastname: Saboye
authors.affiliation: Service de chirurgie plastique, reconstructrice et des brûlés, CHU Rangueil, 1, avenue du Pr Jean Poulhès, TSA 50032, 31059 Toulouse cedex, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Chavoin
authors.affiliation: Service de chirurgie orthopédique, traumatologique, plastique, reconstructrice et assistance main, CHU Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon cedex, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Tropet
authors.affiliation: Service de chirurgie plastique, reconstructrice et des brûlés, CHU Rangueil, 1, avenue du Pr Jean Poulhès, TSA 50032, 31059 Toulouse cedex, France.
authors.forename: J L
authors.initials: JL
authors.lastname: Grolleau
authors.affiliation: Service de chirurgie plastique, reconstructrice et des brûlés, CHU Rangueil, 1, avenue du Pr Jean Poulhès, TSA 50032, 31059 Toulouse cedex, France. Electronic address: benoitchaput31@gmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Chaput
mesh_terms: D005731:Ganglionic Stimulants / Q000009:adverse effects / Q000493:pharmacokinetics; D006801:Humans; D000860:Hypoxia / Q000503:physiopathology; D007511:Ischemia / Q000503:physiopathology; D009538:Nicotine / Q000009:adverse effects / Q000493:pharmacokinetics; D011183:Postoperative Complications / Q000503:physiopathology*; D019651:Plastic Surgery Procedures; D012907:Smoking / Q000009:adverse effects / Q000503:physiopathology*; D016540:Smoking Cessation; D061485:Tobacco Use Cessation Devices; D014945:Wound Healing / Q000502:physiology*
chemical_list: D005731:Ganglionic Stimulants; D009538:Nicotine
keywords: Chirurgie plastique; Cicatrisation; Nicotine replacement therapy; Physiopathologie; Physiopathology; Plastic surgery; Preoperative nicotine withdrawal; Sevrage tabagique préopératoire; Smoking; Tabagisme; Traitement substitutif nicotinique; Wound healing