Pluvy I, Panouillères M, Garrido I, Pauchot J, Saboye J, Chavoin J P, Tropet Y, Grolleau J L, Chaput B
Service de chirurgie orthopédique, traumatologique, plastique, reconstructrice et assistance main, CHU Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon cedex, France.
Service de chirurgie plastique, reconstructrice et des brûlés, CHU Rangueil, 1, avenue du Pr-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex, France.
Ann Chir Plast Esthet. 2015 Feb;60(1):e15-49. doi: 10.1016/j.anplas.2014.09.011. Epub 2014 Oct 25.
Tobacco addiction is a risk factor for complication in plastic surgery. The authors have assembled concrete arguments detailing the risks of perioperative and postoperative complication that are incurred by a patient with continued tobacco intoxication who wishes to undergo a surgical intervention.
Through application of the PRISMA criteria, we have carried out a systematic review of the literature, in which we explored five databases while using predefined keywords. We selected randomized, controlled observational studies on the perioperative and postoperative complications related to tobacco use in actively smoking, abstinent and non-smoking patients.
The levels of evidence for each article were evaluated. Risk of bias was assessed using the Newcastle-Ottawa Scale. Incidence parameters including the Odds Ratio and relative risk were calculated for each complication of which the number of occurrences had been indicated. Meta-analysis of the results was carried out.
We included 60 observational studies. In the cosmetic surgery group, we calculated a combined Odds Ratio of 2.3 [1.51-3.54] P<0.001 for surgical site infections and 2.5 [1.49-4.08] P<0.001 for delayed wound healing. In the bariatric surgery sequelae group, we found a combined Odds Ratio of 3.3 [1.90-5.64] P<0.001 with regard to delayed wound healing and 3.1 [1.39-7.13] P=0.006 for cutaneous necrosis. No proof was provided as to the possible influence of tobacco on the success rate of free flap microsurgery, but it is difficult to extrapolate results on the latter to digital reimplantation.
The review underlines the fact that patients with smoking habits run a significantly heightened risk of cutaneous necrosis, particularly in the event of major detachment (cervico-facial lift, skin-sparing mastectomy, abdominoplasty), of additionally delayed wound healing and of addition surgical site infections. Rigorous preoperative evaluation of smokers could help to diminish these risks.
烟草成瘾是整形手术并发症的一个风险因素。作者收集了具体论据，详细阐述了持续吸烟中毒的患者在希望接受手术干预时围手术期和术后并发症的风险。
通过应用PRISMA标准，我们对文献进行了系统回顾，在回顾过程中我们使用预定义关键词搜索了五个数据库。我们选择了关于主动吸烟、戒烟和非吸烟患者烟草使用相关围手术期和术后并发症的随机对照观察性研究。
评估了每篇文章的证据水平。使用纽卡斯尔-渥太华量表评估偏倚风险。针对每种已表明发生次数的并发症，计算包括比值比和相对风险在内的发病率参数。对结果进行了荟萃分析。
我们纳入了60项观察性研究。在整形手术组中，我们计算出手术部位感染的合并比值比为2.3[1.51 - 3.54]，P<0.001；伤口愈合延迟的合并比值比为2.5[1.49 - 4.08]，P<0.001。在减肥手术后遗症组中，我们发现伤口愈合延迟的合并比值比为3.3[1.90 - 5.64]，P<0.001；皮肤坏死的合并比值比为3.1[1.39 - 7.13]，P = 0.006。没有证据表明烟草对游离皮瓣显微外科手术成功率可能产生影响，但很难将后者的结果外推至断指再植。
该综述强调了有吸烟习惯的患者发生皮肤坏死的风险显著增加这一事实，尤其是在进行大型剥离手术（颈面部提升术、保留皮肤的乳房切除术、腹部整形术）时，还会有伤口愈合额外延迟和手术部位感染增加的情况。对吸烟者进行严格的术前评估有助于降低这些风险。
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