%0 Journal Article
%T Smoking and Flap Survival
%A Ji Soo Son
%A Kun Hwang
%A Woo Kyung Ryu
%J Plastic Surgery
%@ 2292-5511
%D 2018
%R 10.1177/2292550317749509
%X The aim of this study was to compare the complications of flap surgery in non-smokers and smokers and to determine how the incidence of complications was affected by the abstinence period from smoking before and after flap surgery. In PubMed and Scopus, terms ˇ°smokingˇ± and ˇ°flap survivalˇ± were used, which resulted in 113 papers and 65 papers, respectively. After excluding 6 duplicate titles, 172 titles were reviewed. Among them, 45 abstracts were excluded, 20 full papers were reviewed, and finally 15 papers were analyzed. Post-operative complications such as flap necrosis (P < .001), hematoma (P < .001), and fat necrosis (P = .003) occurred significantly more frequently in smokers than in non-smokers. The flap loss rate was significantly higher in smokers who were abstinent for 24 hours post-operatively than in non-smokers (n = 1464, odds ratio [OR] = 4.885, 95% confidence interval [CI] = 2.071-11.524, P < .001). The flap loss rate was significantly lower in smokers who were abstinent for 1 week post-operatively than in those who were abstinent for 24 hours post-operatively (n = 131, OR = 0.252, 95% CI = 0.074-0.851, P = .027). No significant difference in flap loss was found between non-smokers and smokers who were abstinent for 1 week preoperatively (n = 1519, OR = 1.229, 95% CI = 0.482-3.134, P = .666) or for 4 weeks preoperatively (n = 1576, OR = 1.902, 95% CI = 0.383-2.119, P = .812). Since smoking decreases the alveolar oxygen pressure and subcutaneous wound tissue oxygen, and nicotine causes vasoconstriction, smokers are more likely to experience flap loss, hematoma, or fat necrosis than non-smokers. Preoperative and post-operative abstinence period of at least 1 week is necessary for smokers who undergo flap operations
%K smoking
%K surgical flaps
%K post-operative complications
%K hematoma
%K fat necrosis
%K meta-analysis
%U https://journals.sagepub.com/doi/full/10.1177/2292550317749509