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Smoking and Tobacco

How does smoking complicate wound healing?



I have 2 questions. My best friend just had a facelift. Her Doctor advised her to quit smoking 4 weeks before surgery and for 8 weeks after. She quit for 1 week before and started back 1 week after. She has not told her doctor this, because he told her before surgery that cigarette smoking can seriously complicate wound healing. She appears to be doing ok. Question 1- Can you explain in detail what complication she can have in the healing of the scars or wound area? She says she was told she could not use patches because they contain nicitine. She used Zyban before to quit; however she says it is not having the same effect as before. Question 2- Is there any other alternatives to reccomend?


Question 1. An immediate effect of cigarette smoking is that it decreases capillary and arteriolar blood flow in the skin. Adequate oxygen and nutrients are needed for tissue healing. Nicotine in cigarette smoke narrows the blood vessels, so this is probably the reason that nicotine patches were not recommended. There are several studies that also show a strong relationship between cigarette smoking and facial wrinkling in Caucasians. The exact mechanism is not clear, but there are increased wrinkles around the eyes and lips and grayish-colored skin in smokers compared to nonsmokers of the same age and same sun exposure. Question 2. Since your friend had success with Zyban and not smoking in the past, it is certainly important to continue taking it at this time as she quits smoking again. About 7 days of Zyban medication are needed for the body to reach a level of the medication for it to be effective. That is why it is prescribed one week prior to the person`s quit date. Encourage your friend to take Zyban as ordered by her physician for at least 7 consecutive days. You can be helpful by reducing environmental cues that remind her of smoking, provide alternatives to smoking, and praise her on a daily basis for not smoking.

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Response by:

Karen L Ahijevych, PhD, RN, FAAN Karen L Ahijevych, PhD, RN, FAAN
Professor Emeritus
College of Public Health
College of Nursing
The Ohio State University