Wolters: Cigarette smokers are at increased risk of complications after plastic surgery. Could e-cigarette users face a similar risk? Evidence and recommendations related to e-cigarette use by plastic surgery patients are discussed in a special topic paper in the December issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). "Refraining from [e-cigarette] use four weeks before surgery is a prudent course of action, despite the fact that it has yet to be determined if the effects are similar to traditional cigarettes," write ASPS Member Surgeons Dr. Peter Taub of Mount Sinai Medical Center and Dr. Alan Matarasso of Albert Einstein College of Medicine, both in New York City.
Potential Harms Lead to Advice to Stop E-Cig Use before Plastic Surgery
The researchers reviewed previous research on the potential health
effects of e-cigarettes, with the goal of making recommendations for
patients undergoing plastic and reconstructive surgery. Use of
e-cigarettes—sometimes called "vaping"—has rapidly gained in popularity
in recent years.
It has been suggested that e-cigarettes may be safer than traditional
cigarettes, and might even be a useful "bridge" to smoking cessation.
But there's also continued concern about the potential harmful health
effects of e-cigarettes.
"The long-term effects of inhaling nicotine vapor are unclear, but
there is no evidence to date that it causes cancer or heart disease as
cigarette smoking does," Drs. Taub and Matarasso write. They note that
the US Food and Drug Administration has published a "cautious blueprint"
for the regulation of e-cigarettes.
The concern about e-cigarette use stems from the increased risk of
complications after plastic surgery in cigarette smokers. Patients who
smoke are more likely to have failure of the skin flaps used for many
types of plastic and reconstructive surgery procedures. These skin flap
complications are thought to be related to nicotine-induced reductions
in blood flow (vasoconstriction).
Many "vapers" use e-cigarette solutions that contain nicotine, which
might lead to similar adverse effects. The risk isn't necessarily the
same, as cigarette smoke also contains other compounds that might affect
blood flow. But there are also questions about other potentially toxic
substances in e-cigarette vapor.
In one study of general surgery patients, quitting smoking for three
or four weeks before surgery reduced the complication rate from about 40
to 20 percent. Based on this and other high-quality evidence, cigarette
smokers are strongly advised to stop smoking at least four weeks before
plastic surgery procedures.
A similar guideline should apply to the use of e-cigarettes before
plastic surgery, Drs. Taub and Matarasso believe. They write: "Based on
our current best knowledge, it seems reasonable to advise plastic
surgery candidates to cease e-cigarette use in a manner similar to what
is advised for [cigarettes]." Especially with the rising rate of
e-cigarette use in the population, plastic surgeons should be aware of
the possible increase in risk, and advise their patients accordingly.
Meanwhile, the authors acknowledge the lack of direct evidence
showing that the nicotine in e-cigarette vapor increases the risk of
blood flow-related complications. They conclude: "More definitive
research might elucidate the effects of vaporized nicotine on the
survival of skin and soft tissue flaps, as they most intimately relate
to the safe practice of plastic surgery."
Plastic and Reconstructive Surgery® is published by Wolters Kluwer.
Click here to read “E-Cigarettes and Potential Implications for Plastic Surgery.”
Articles: “E-Cigarettes and Potential Implications for Plastic Surgery” (doi: 10.1097/PRS.0000000000002742)