Service de chirurgie plastique, reconstructrice et esthétique, Hôpital Tenon AP-HP, 4 rue de la Chine, 75020 Paris 20, France.
Service de chirurgie plastique, reconstructrice et esthétique, Hôpital Tenon AP-HP, 4 rue de la Chine, 75020 Paris 20, France.
Ann Chir Plast Esthet. 2022 Jun;67(3):119-124. doi: 10.1016/j.anplas.2022.05.001. Epub 2022 Jun 4.
Smokers are more likely to undergo postoperative complications after plastic surgeries. Our main purpose was to update nicotine's effects after plastic surgeries and assess whether nicotine-replacement therapy and vaping are safe enough to be recommended in peri-operatory circumstances.
We set up a literature review including 40 documents from 1986 to 2020 available on Pubmed.
Nicotine has undeniable detrimental effects on patients undergoing plastic surgeries like cutaneous necrosis, skin flap failure and surgical site infection. Nevertheless, this toxicity seems to depend on the plasma concentration of nicotine and thus on the way of administration. While smoking is definitely harmful, nicotine replacement therapies (NRT) like patches and gums do not appear to increase postoperative risks based on available studies. The situation is different with the electronic cigarette since the pharmacokinetic parameters are close to those of the traditional cigarette. Even if powerful studies are lacking because the device is recent, preliminary in vitro studies and case reports suggest non-zero surgical risks for e-cigarette users.
It seems more appropriate to suggest stopping all nicotine intake before and after plastic surgery. However, if strict cessation is not achievable, it appears preferable to use nicotine replacement therapies rather than e-cigarettes and most of all tobacco.
吸烟者在接受整形手术后更有可能出现术后并发症。我们的主要目的是更新尼古丁在整形手术后的影响，并评估尼古丁替代疗法和电子烟在围手术期是否足够安全，值得推荐。
我们进行了一项文献综述，纳入了 1986 年至 2020 年期间在 Pubmed 上发表的 40 篇文献。
尼古丁对接受整形手术的患者有不可否认的有害影响，如皮肤坏死、皮瓣失败和手术部位感染。然而，这种毒性似乎取决于尼古丁的血浆浓度，因此也取决于给药方式。虽然吸烟肯定是有害的，但基于现有研究，尼古丁替代疗法（NRT）如贴片和口香糖似乎不会增加术后风险。电子烟的情况则不同，因为其药代动力学参数与传统香烟非常接近。尽管由于该设备是新的，缺乏强有力的研究，但初步的体外研究和病例报告表明，电子烟使用者存在非零的手术风险。
似乎更适合建议在整形手术前后停止所有尼古丁摄入。然而，如果严格戒烟不可行，使用尼古丁替代疗法似乎比电子烟更可取，而电子烟又比烟草更可取。
