Nicotine has deleterious effects on wound healing through increased vasoconstrictionBMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2709 (Published 17 May 2016) Cite this as: BMJ 2016;353:i2709
All rapid responses
I welcome the information provided by Davies and Ismail (1) highlighting the effects of nicotine on wound healing through increased vasoconstriction. But they failed to mention the immunosuppressive effects of nicotine, which acts via leukocyte membrane nicotinic receptors to increase the rate of post-operative infections and reduces tissue regeneration (2). This is important in plastic surgery and also in orthopaedic procedures as nicotine is known to reduce bone growth and increase rejection of the prosthesis (3).
There is the added complication that many smokers (and users of e-cigarettes) deny their habit or under-report their tobacco usage (4). It is therefore important to use biochemical monitoring at pre-operative assessment to identify smokers and take appropriate steps towards smoking cessation. In the case of tobacco expired-air carbon monoxide (eCO) is frequently used to assess usage but as e-cigarettes do not generate CO then a viable alternative is point of care cotinine testing, which can detect nicotine intake over the previous 3 days (5).
1. Davies CS, Ismail A. Nicotine has deleterious effects on wound healing through increased vasoconstriction. BMJ 2016;353:i2709
2. Cope GF. Smoking what all healthcare professionals need to know. M&K Publishing 2016
3. Singh JA, Schleck C, Harmsen WS et al. Current tobacco use is associated with higher rates of implant revision and deep infection after total hip or knee arthroplasty: a prospective cohort study. BMC Med 2015;13:Art No 283
4. Payne CE, Southern SJ. Urinary point-of-care test for smoking in the pre-operative assessment of patients undergoing elective plastic surgery. J Plast Reconstr Aesth Surg 2006;59:1156-1161
5. Cope GF, Wu HHT, O'Donovan GV et al. A new point of care cotinine test for saliva to identify and monitor smoking habit. Eur Resp J 2012:40:496-497
Competing interests: Dr Cope is the inventor of a point of care cotinine test called SmokeScreen and is the Technical Director of the manufacturer GFC Diagnostics Ltd.