Topics

Intro
Cigarette Smoke
Nicotine
Carbon Monoxide
Other Substances
Smoke and Bone
Bone Healing
Wound Healing
Osteonecrosis
Lower Back Pain
Arthritis
Dupuytrens
RSD (CRPS)
Summary
Bibliography

Wound Healing

Delayed healing of a hand wound in a smoker was initially described by Mosely and Finseth in 1977.72 Spinal cord patients who are smokers have a higher incidence of pressure sores and the areas of necrosis are more extensive.61

Postoperative wound complications in cosmetic procedures is significantly higher in smokers.82 83 98 A study comparing the cosmetic results of incisions with smokers and nonsmokers found that the smokers, in general, had inferior cosmetic results.96

These results can be analogized to postoperative orthopaedic patients. A higher incidence of wound infection and delayed would healing has been verified in patients undergoing spine surgery.16 Additional studies are needed to investigate the true impact of smoking upon orthopaedic surgical patients.

Mechanisms for delayed healing include tissue ischemia produced by vasoconstriction, increased platelet adhesives and microvascular clotting, with diminished oxygen transport due to the combined effects of carbon monoxide and nicotine toxicity.95 In addition, the catecholamine release in response to nicotine may stimulate the formation of chalones or hormones which inhibit epithelialization, and undermine wound repair.73

Nicotine is toxic to fibroblasts and macrophages,77 both of which transport healing substances to the wound area. In addition, fibroblasts manufacture collagen which is necessary for scar formation. Hydrogen cyanide can inhibit the enzyme systems required for oxidative metabolism and oxygen transport at the cellular level.72