The effect of smoking on muscle transposition

Smoking has been shown to be a complicating factor in normal wound healing. Both nicotine and carbon monoxide adversely affect multiple stages of the healing process. From 1976 to 1990, 1034 muscle flap procedures were performed on 722 patients on a single surgical service. A retrospective review of 300 patients completed; patients were divided into three groups: group 1, no smoking history; group 2, smokers for at least 10 pack/years but had quit for at least 1 year; and group 3, active smokers at the time of surgery. Patients were omitted who had diabetes, had received radiation therapy or chemotherapy, had a recurrent malignancy, or used steroids. A total of 300 consecutive patients were entered into the study. Active smokers were shown to have a complication rate significantly higher in the immediate postoperative period compared with nonsmokers and smokers who had quit. The most common complications were partial muscle necrosis and partial skin graft loss. This series suggests that active smoking at the time of muscle transposition significantly increases the rate of postoperative complications.