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A recent study has shown that electronic cigarettes (e-cigarettes) have been linked to post-surgical complications, although it is yet to be determined if the effects are similar to those caused by traditional cigarette use.

It is a well researched and known fact that the use of tobacco products, especially smoking of cigarettes, is directly related to post-surgical complications such as delayed wound healing and unfavourable outcomes in delicate procedures such as those performed in plastic and reconstructive surgery. These patients who smoke cigarettes are more likely to have problems with their skin grafts or flaps, which are performed for many types of plastic and reconstructive surgeries. These skin graft or flap complications are thought to be related to reductions in blood flow caused by nicotine and current journal entries have noted the potential complications that may be caused by nicotine in these tobacco products, especially in those patients who are smokers and who have had plastic surgery performed.

There has been a growing popularity in the use of electronic cigarettes which use electricity to vaporize the contents in the apparatus, which is liquid nitrogen that is flavoured to the user's preference. What is not known about these e-cigarettes is whether there are any health-related issues that are associated with their use. These concerns extend to whether these e-cigarettes are associated with any post-surgical complications, especially in plastic and reconstructive surgeries where positive outcomes rely heavily on a good blood supply of the wound bed of the patient or the donor tissue.

This concern regarding e-cigarettes was raised because of the increased risk of complications, after plastic and reconstructive surgery, in patients who smoked cigarettes. Since e-cigarettes use nicotine-containing solutions, which might lead to the mentioned skin flap issues, further research into the possibility of e-cigarettes causing this problem was warranted.

The research

Researchers looked at previous research papers that investigated the possible health-related effects that the use of electronic cigarettes, or "vaping", could have on a person. The aim of this research was to determine if there were any concerns regarding the topic and therefore make suggestions for patients undergoing plastic or reconstructive surgery who do "vape".

The findings

The researchers made the following deductions:

  • Using e-cigarettes seems to be a safer choice than cigarette smoking, and may even be helpful in patients who are trying to quit using tobacco products by acting as a substitute to slowly get away from being reliant on nicotine.
  • It's unclear what the chronic effects of inhaling nicotine vapour is, but there wasn't any evidence found that these chemicals resulted in the development of cardiovascular diseases or cancer like cigarette smoking does.
  • Since cigarette smoke also contains other chemicals and compounds that may cause restrictions in blood flow, the risk of e-cigarettes causing skin flap issues doesn't seem to be the same. However, there are queries regarding other possible hazardous toxins that may be found in electronic cigarette vapour. Clearly, further research is needed into these aspects.
  • In a previous study that was conducted on general surgery patients, it was found that abstaining from smoking for 3 or 4 weeks before surgery was performed, decreased the rate of post-surgical complications rate from 40% down to 20%.

The clinical significance

Based on this and their other findings, the researchers suggested that patients refrain from using their e-cigarettes for 4 weeks before plastic and reconstructive surgery is performed, even though it hasn't been determined yet if the effects are similar to cigarette smoking. It is recommended then that plastic and reconstructive surgeons advice their patients accordingly. 

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