SLR - November 2019 - Dana V. Day
Reference: Troiano C, Jaleel Z, Spiegel JH. Association of Electronic Cigarette Vaping and Cigarette Smoking with Decreased Random Flap Viability in Rats. JAMA Facial Plastic Surgery. 2019 Jan 1; 21(1):5-10Reviewed By: Dana V. Day, DPM
Residency Program: Chino Valley Medical Center – Chino, CA
Podiatric Relevance: Within the past few years, the use of electronic cigarettes and vaping has risen significantly. Vaping provides a form of tobacco that is more appealing in that it is delivered in a mist, flavored, and has been marketed as safer than smoking cigarettes. It is well known that smoking traditional tobacco cigarettes is linked to increased complications with wound healing; however, the effects of vaping on wound healing and flap viability are not well documented. This study used rat models to evaluate the rate of flap necrosis between e-cigarette vapor, traditional cigarette smoke, and an unexposed control.
Methods: A cohort study with 45 male Sprague-Dawley rats was performed. The rats, all weighing approximately 100 grams, were randomized into three groups: 15 rats in the negative control that were not exposed to any nicotine substance, 15 rats in the experimental were exposed to e-cigarette vapor, and 15 in the positive control that were exposed to traditional cigarette smoke. The rats in the experimental and positive control groups were placed in smoking chambers for 30 minutes twice a day for 30 consecutive days with a maintained serum cotinine (a biomarker for exposure to tobacco smoke) level of 150 to 500 ng/mL, equivalent to smoking one pack per day. After 30 days, a random flap on the dorsum of the 45 rats was surgically raised to the level of the fascia and reapproximated using skin staples. Flaps were monitored daily for two weeks for viability and necrosis, which was determined by appearance, turgor, and capillary refill.
Results: All 45 rats survived the procedure and postoperative recovery. All of the rats also thrived and gained weight over the progression of this study. The highest rate of flap necrosis was found in the positive control (traditional cigarette smoke), followed by the experimental cohort (e-cigarette vapor), and the negative control cohort had the least amount of flap necrosis. No statistical difference in flap necrosis was observed between the positive and experimental cohorts of rats.
Conclusions: The authors concluded that both smoking and vaping seem to be equally detrimental to wound healing. They proposed that vaping should not be considered a safer or better alternative to cigarette smoking in regards to wound healing. Surgeons and clinicians should take this into account when counseling patients and optimizing medical management, especially in the preoperative setting. Further studies, particularly looking at human outcomes, are needed to truly appreciate its effects on wound healing.