Does Cigarette Smoking Harm Microsurgical Free Flap Reconstruction?

Abstract

Background Free tissue transfers can successfully address a wide range of reconstructive requirements. While the negative influence of cigarette smoking is well documented, its effects in the setting of microsurgical free flap reconstruction remain debated. This study evaluates the impact of cigarette smoking on microsurgical reconstructions.

Methods Over a 7-year period, 897 patients underwent 969 microvascular free flap reconstructions at a single surgical center. The cases were divided into “smoker” (S) and “nonsmoker” (NS) groups according to their cigarette smoking status. The data were retrospectively screened for patients' demographics, perioperative details, surgical complications, free flap types, recipient sites, flap survival, and overall outcomes.

Results Both groups were comparable regarding comorbidities including hypertension, peripheral artery disease, diabetes, American Society of Anesthesiologists scores, types of performed free flaps, and recipient sites. While patients in the NS group were significantly older and had a higher prevalence of obesity (p < 0.05), there were no significant differences regarding the rate of major or minor complications during our 3-month follow-up period (p > 0.05).

Conclusion While minor and major complications were increased regarding virtually all examined parameters, cigarette smoking did not have significant effects on the overall outcomes of microsurgical free flap reconstructions.

Keywords

cigarette smoking - nicotine - free flap reconstruction

• References

• 1 Heidekrueger PI, Heine-Geldern A, Ninkovic M. , et al. Microsurgical reconstruction in patients greater than 80 years old. Microsurgery 2017; 37 (06) 546-551
• 2 Klein HJ, Fuchs N, Mehra T. , et al. Extending the limits of reconstructive microsurgery in elderly patients. J Plast Reconstr Aesthet Surg 2016; 69 (08) 1017-1023
• 3 Riot S, Herlin C, Mojallal A. , et al. A systematic review and meta-analysis of double venous anastomosis in free flaps. Plast Reconstr Surg 2015; 136 (06) 1299-1311
• 4 Tran NV, Buchel EW, Convery PA. Microvascular complications of DIEP flaps. Plast Reconstr Surg 2007; 119 (05) 1397-1405 , discussion 1406–1408
• 5 Spear SL, Ducic I, Cuoco F, Hannan C. The effect of smoking on flap and donor-site complications in pedicled TRAM breast reconstruction. Plast Reconstr Surg 2005; 116 (07) 1873-1880
• 6 Reus III WF, Colen LB, Straker DJ. Tobacco smoking and complications in elective microsurgery. Plast Reconstr Surg 1992; 89 (03) 490-494
• 7 Reus WF, Robson MC, Zachary L, Heggers JP. Acute effects of tobacco smoking on blood flow in the cutaneous micro-circulation. Br J Plast Surg 1984; 37 (02) 213-215
• 8 Chang DW, Reece GP, Wang B. , et al. Effect of smoking on complications in patients undergoing free TRAM flap breast reconstruction. Plast Reconstr Surg 2000; 105 (07) 2374-2380
• 9 van Adrichem LN, Hoegen R, Hovius SE. , et al. The effect of cigarette smoking on the survival of free vascularized and pedicled epigastric flaps in the rat. Plast Reconstr Surg 1996; 97 (01) 86-96
• 10 Zimmerman DD, Delemarre JB, Gosselink MP, Hop WC, Briel JW, Schouten WR. Smoking affects the outcome of transanal mucosal advancement flap repair of trans-sphincteric fistulas. Br J Surg 2003; 90 (03) 351-354
• 11 Sanati-Mehrizy P, Massenburg BB, Rozehnal JM, Ingargiola MJ, Hernandez Rosa J, Taub PJ. Risk factors leading to free flap failure: analysis from the National Surgical Quality Improvement Program Database. J Craniofac Surg 2016; 27 (08) 1956-1964
• 12 Lin CH, Lin YT, Yeh JT, Chen CT. Free functioning muscle transfer for lower extremity posttraumatic composite structure and functional defect. Plast Reconstr Surg 2007; 119 (07) 2118-2126
• 13 Lorenzo AR, Lin CH, Lin CH. , et al. Selection of the recipient vein in microvascular flap reconstruction of the lower extremity: analysis of 362 free-tissue transfers. J Plast Reconstr Aesthet Surg 2011; 64 (05) 649-655
• 14 Bauermeister AJ, Zuriarrain A, Newman M, Earle SA, Medina III MA. Impact of continuous two-team approach in autologous breast reconstruction. J Reconstr Microsurg 2017; 33 (04) 298-304
• 15 Weichman KE, Lam G, Wilson SC. , et al. The impact of two operating surgeons on microsurgical breast reconstruction. Plast Reconstr Surg 2017; 139 (02) 277-284
• 16 Blackwell KE, Azizzadeh B, Ayala C, Rawnsley JD. Octogenarian free flap reconstruction: complications and cost of therapy. Otolaryngol Head Neck Surg 2002; 126 (03) 301-306
• 17 Kim HK, Park B, Bae TH, Kim WS. Comparative study of the postoperative complications of microvascular surgery in elderly and young patients. J Reconstr Microsurg 2011; 27 (04) 219-224
• 18 Serletti JM, Higgins JP, Moran S, Orlando GS. Factors affecting outcome in free-tissue transfer in the elderly. Plast Reconstr Surg 2000; 106 (01) 66-70
• 19 Simunovic F, Eisenhardt SU, Penna V, Thiele JR, Stark GB, Bannasch H. Microsurgical reconstruction of oncological scalp defects in the elderly. J Plast Reconstr Aesthet Surg 2016; 69 (07) 912-919
• 20 Chang SY, Huang JJ, Tsao CK. , et al. Does ischemia time affect the outcome of free fibula flaps for head and neck reconstruction? A review of 116 cases. Plast Reconstr Surg 2010; 126 (06) 1988-1995
• 21 Bhama PK, Patel SA, Khan U, Bhrany AD, Futran ND. Head and neck free flap reconstruction in patients older than 80 years. J Reconstr Microsurg 2014; 30 (08) 523-530
• 22 Laporta R, Sorotos M, Longo B, Santanelli di Pompeo F. Breast reconstruction in elderly patients: risk factors, clinical outcomes, and aesthetic results. J Reconstr Microsurg 2017; 33 (04) 257-267
• 23 Spyropoulou GA, Jeng SF, Hsieh CH, Tsimponis A, Shih HS. Microsurgical reconstruction for head and neck cancer in elderly patients. J Reconstr Microsurg 2014; 30 (02) 91-96
• 24 Davis JW, Davis RF. Acute effect of tobacco cigarette smoking on the platelet aggregate ratio. Am J Med Sci 1979; 278 (02) 139-143
• 25 Hawkins RI. Smoking, platelets and thrombosis. Nature 1972; 236 (5348): 450-452
• 26 Levine PH. An acute effect of cigarette smoking on platelet function. A possible link between smoking and arterial thrombosis. Circulation 1973; 48 (03) 619-623
• 27 Michael Pittilo R. Cigarette smoking, endothelial injury and cardiovascular disease. Int J Exp Pathol 2000; 81 (04) 219-230
• 28 Pittilo RM. Cigarette smoking and endothelial injury: a review. Adv Exp Med Biol 1990; 273: 61-78
• 29 Rao VK, Morrison WA, O'Brien BM. Effect of nicotine on blood flow and patency of experimental microvascular anastomosis. Ann Plast Surg 1983; 11 (03) 206-209
• 30 Valentini V, Cassoni A, Marianetti TM, Battisti A, Terenzi V, Iannetti G. Anterolateral thigh flap for the reconstruction of head and neck defects: alternative or replacement of the radial forearm flap?. J Craniofac Surg 2008; 19 (04) 1148-1153
• 31 Yaffe B, Cushin BJ, Strauch B. Effect of cigarette smoking on experimental microvascular anastomoses. Microsurgery 1984; 5 (02) 70-72
• 32 Rosenberg AJ, Van Cann EM, van der Bilt A, Koole R, van Es RJ. A prospective study on prognostic factors for free-flap reconstructions of head and neck defects. Int J Oral Maxillofac Surg 2009; 38 (06) 666-670
• 33 Eckardt A, Fokas K. Microsurgical reconstruction in the head and neck region: an 18-year experience with 500 consecutive cases. J Craniomaxillofac Surg 2003; 31 (04) 197-201
• 34 Wong AK, Joanna Nguyen T, Peric M. , et al. Analysis of risk factors associated with microvascular free flap failure using a multi-institutional database. Microsurgery 2015; 35 (01) 6-12
• 35 Nolan MB, Warner DO. Safety and efficacy of nicotine replacement therapy in the perioperative period: a narrative review. Mayo Clin Proc 2015; 90 (11) 1553-1561
• 36 Pluvy I, Garrido I, Pauchot J. , et al. Smoking and plastic surgery, part I. Pathophysiological aspects: update and proposed recommendations. Ann Chir Plast Esthet 2015; 60 (01) e3-e13