The Effect of Smoking on Necrosis Rate in Digital Replantation and Revascularization with Prostaglandin E1 Therapy: A Retrospective Study.
BACKGROUND
Most microsurgeons believe that smoking and severity of injury adversely affect the outcome of digital replantation surgery. As countermeasures, several pharmacologic agents have been used for the perioperative period. The purpose of this retrospective study was to examine whether the rate of necrosis is appreciably different across smokers versus nonsmokers with prostaglandin E1 therapy.


METHODS
The authors' study subjects included 144 patients (184 digits) who underwent replantation or revascularization between August of 2013 and August of 2015.The primary outcome was the incidence of total necrosis after replantation surgery, and the secondary outcomes were the rate of overall necrosis, proportion of total necrosis to overall necrosis, and total success. Intravenous administration of prostaglandin E1 was performed at the rate of 120 μg/day for 7 days after surgery in all patients. These outcomes of each injury type were compared between smoking and nonsmoking groups.


RESULTS
Among the 184 injured digits, the incidence of total necrosis in smokers (23 percent) was higher than that in nonsmokers (17 percent), although no significant difference was shown (p = 0.36). The adjusted odds ratio was 1.17 (95 percent CI, 0.51 to 2.69). Similarly, there was no significant difference in the secondary outcomes between the two groups.


CONCLUSIONS
The authors' retrospective study found no significant difference in the formation or extent of necrosis after replantation or revascularization between smoking and nonsmoking groups when all patients were treated with prostaglandin E1.


METHODS
Risk, II.
Matsudo and Tokyo, Japan.|From the Department of Plastic and Reconstructive Surgery, New Tokyo Hospital; and the Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba.
Akio
A
Nishijima
Matsudo and Tokyo, Japan.|From the Department of Plastic and Reconstructive Surgery, New Tokyo Hospital; and the Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba.
Naoto
N
Yamamoto
Matsudo and Tokyo, Japan.|From the Department of Plastic and Reconstructive Surgery, New Tokyo Hospital; and the Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba.
Satoshi
S
Yanagibayashi
Matsudo and Tokyo, Japan.|From the Department of Plastic and Reconstructive Surgery, New Tokyo Hospital; and the Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba.
Ryuichi
R
Yoshida
Matsudo and Tokyo, Japan.|From the Department of Plastic and Reconstructive Surgery, New Tokyo Hospital; and the Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba.
Megumi
M
Takikawa
Matsudo and Tokyo, Japan.|From the Department of Plastic and Reconstructive Surgery, New Tokyo Hospital; and the Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba.
Rie
R
Kouno
Matsudo and Tokyo, Japan.|From the Department of Plastic and Reconstructive Surgery, New Tokyo Hospital; and the Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba.
Masahiko
M
Gosho
D000328:Adult; D000368:Aged; D000527:Alprostadil / Q000627:therapeutic use*; D000673:Amputation, Traumatic / Q000473:pathology / Q000601:surgery*; D005260:Female; D005383:Finger Injuries / Q000473:pathology / Q000601:surgery*; D005385:Fingers / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009336:Necrosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D018919:Neovascularization, Physiologic; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D012092:Replantation; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D014665:Vasodilator Agents / Q000627:therapeutic use*
D014665:Vasodilator Agents; D000527:Alprostadil
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