Cigarette smoking causes delayed wound healing.
By looking at the individual toxic effects of the constituents of cigarette smoke, we can understand the potential mechanisms through which smoking slows down or undermines wound healing.
According to the CDC, “tobacco smoke contains a deadly mix of more than 7,000 chemicals. Hundreds are toxic. About 70 can cause cancer.” To begin to understand the effects of smoking on wound healing, it suffices to look at the toxic effects of just three of those chemicals: nicotine, carbon monoxide, and hydrogen cyanide.
Nicotine is a vasoconstrictor that reduces nutritional blood flow to the skin, resulting in tissue ischemia and impaired healing of injured tissue. Nicotine also increases platelet adhesiveness, raising the risk of thrombotic microvascular occlusion and tissue ischemia. In addition, proliferation of red blood cells, fibroblasts, and macrophages is reduced by nicotine.
Carbon monoxide diminishes oxygen transport and metabolism, and
Hydrogen cyanide inhibits the enzyme systems necessary for oxidative metabolism and oxygen transport at the cellular level.
Slower healing has been observed clinically in smokers with wounds resulting from trauma, disease, or surgical procedures. The reduced capacity for wound repair is a particular concern in patients undergoing plastic or reconstructive surgery. Compared with nonsmokers, smokers have a higher incidence of unsatisfactory healing after face-lift surgery, as well as a greater degree of complications following breast surgery. Smokers should be advised to stop smoking prior to elective surgery or when recovering from wounds resulting from trauma, disease, or emergent surgery.” http://www.ncbi.nlm.nih.gov/pubmed/1323208
Dr. Johnson at DRMC advises his surgical patients to stop smoking for at least six weeks before he repairs their hernias, which are often elective procedures.