Why is stopping smoking important for wound healing?

From the Guidelines

Stopping smoking is crucial for optimal wound healing, and smokers should quit smoking completely at least 4 weeks before surgery to improve outcomes. Smokers have an increased risk of intra- and postoperative complications, including wound-healing complications, as noted in the guidelines for perioperative care in elective abdominal and pelvic surgery 1. Nicotine and other chemicals in cigarettes cause blood vessels to constrict, reducing blood flow to the wound site, which limits the delivery of oxygen, nutrients, and immune cells necessary for tissue repair. Smoking also increases carbon monoxide levels in the blood, which further reduces oxygen-carrying capacity. Additionally, cigarette smoke contains toxins that impair immune function, making infections more likely and slowing the inflammatory response needed for healing.

Key Points to Consider

• Smoking cessation of 4 to 8 weeks is necessary to reduce respiratory and wound-healing complications 1
• Current smokers have an increased risk for postoperative pulmonary and wound complications, and one month of abstinence from smoking is required to reduce the incidence of complications 1
• Smoking can also impair wound healing and predispose patients to surgical complications for those undergoing reconstructive surgeries after cancer treatment 1
• For those struggling to quit, nicotine replacement therapies such as patches, gum, or prescription medications like varenicline (Chantix) or bupropion (Zyban) can help manage withdrawal symptoms
• Consulting a healthcare provider for a personalized smoking cessation plan is recommended for the best wound healing outcomes

Recommendations for Smoking Cessation

• Quit smoking completely at least 4 weeks before surgery to improve outcomes and reduce the risk of complications
• Use nicotine replacement therapies or prescription medications to manage withdrawal symptoms
• Consult a healthcare provider for a personalized smoking cessation plan
• Avoid passive smoking and the use of electronic cigarettes, which are not harm-free and can have adverse effects on cardiovascular health 1

From the Research

Importance of Stopping Smoking for Wound Healing

• Stopping smoking is crucial for wound healing as it improves tissue oxygenation and metabolism, which are essential for the healing process 2.
• Smoking decreases tissue oxygenation and aerobic metabolism, attenuates the inflammatory healing response, and impairs the proliferative response, leading to delayed healing and complications 2.
• The release of proteolytic enzymes and inhibitors is imbalanced in smokers, which further hinders the wound healing process 2.

Effects of Smoking on Wound Healing

• Smoking has a transient effect on the tissue microenvironment and a prolonged effect on inflammatory and reparative cell functions, leading to delayed healing and complications 2.
• Nicotine does not affect tissue microenvironment but appears to impair inflammation and stimulate proliferation, although the effect is marginal 2.
• Poor oxygenation and the impact of impurities contained in cigarette smoke interfere with wound healing, making it essential for nurses to encourage and support patients to stop smoking 3.

Strategies for Smoking Cessation

• Nurses play a vital role in encouraging and supporting patients to stop smoking, which can be achieved through holistic care and strategies such as urine nicotine testing 4.
• Compulsory urine nicotine testing at the preadmission clinic and prior to the operation can provide objective verification of patients' smoking history, minimize morbidity, and enable healthcare cost savings 4.
• Incorporating evidence-based guidelines for treating tobacco dependence into treatment plans for patients with chronic wounds who smoke can improve wound healing outcomes 5.

Consequences of Continued Smoking

• Continued smoking after surgery can lead to poor surgical results, including impaired wound healing and increased risk of complications 6.
• Education, psychologic consultation, and sometimes refusing to perform aesthetic or reconstructive surgery are required to minimize postoperative complications in smokers 6.