SLR - January 2010 - Daniel Sunboliyan
Reference:
Li Wu Zheng. (2008). Changes in Blood Perfusion and Bone Healing Induced by Nicotine during Distraction Osteogenesis. Bone, 43, 355-361.
Scientific Literature Reviews
Reviewed by: Daniel Sunboliyan, DPM
Residency Program: Kaiser North Bay Consortium.
Podiatric Relevance:
Bone healing is integral to many foot and ankle surgical procedures, unfortunatelymany podiatric patients use tobacco and are exposed to nicotine. This study demonstrates that nicotine exposure may contribute to compromised bone regeneration by the process of vasoconstriction leading to hypoxia.
Methods:
Twenty adult rabbits were divided into a nicotine group and control group. Nicotine was surgically implanted into the nicotine group. After nicotine implantation, a standard procedure of mandibular osteotomy and distraction was conducted. After a latency period of 3 days, distraction was initiated at 0.9mm once daily for 11 days. Five animals in each group were sacrificed at 2 and 4 weeks postoperatively to evaluate for osseous consolidation. The mandibular samples were harvested for analysis. The analysis was performed with the following: Plain film radiography, micro-computed thermography, laser doppler blood flow monitoring, histology and immunohistochemical staining. The measurements were obtained blindly.
Results:
Plainfilm radiographs demonstrated increased bone regenerate in the control group at 2 and 4 weeks. Micro-CT displayed significant increase bone volume regenerate in the control group. Laser doppler depicted a significantly lower blood perfusion in the nicotine group. Histology results at 2 and 4 weeks showed bony union in parts of the distraction regenerate in the control group and cartilage islands in the nicotine group. Immunohistochemical results also yielded a higher expression in the control group.
Conclusions:
In a rabbit model with distraction osteogenesis, nicotine exposure demonstrated lower blood perfusion, and decreased bone regenerate compared to a control group. These results suggest that nicotine exposure can negatively impact postoperative patient outcomes where bone healing is necessary.