Nicotine Replacement Therapy in Head & Neck Microvascular Reconstruction

Head and neck cancer patients requiring microvascular free flap reconstruction are likely to have a recent or active smoking history. Nicotine replacement therapy (NRT) is an option during their hospital stay but sparse evidence exists of its clinical effects. We review the current literature on nicotine replacement therapy (NRT) in microvascular free flap reconstruction. A thorough literature review was conducted using PubMed, analyzing articles relevant to the subject matter. Various search terms were used to identify articles regarding nicotine, nicotine replacement therapy, microvascular anastomosis, and wound healing. Smoking has been shown to have a negative effect on wound healing. Nicotine, however, has opposing effects on the wound healing process. Studies have shown low dose nicotine increases factors related to wound healing like angiogenesis, while high concentrations of nicotine impair these same processes. The two studies using nicotine in microvascular anastomosis animal models demonstrated decreases in flow and anastomotic patency when exposed to nicotine. While no human trial exists, nicotine has been shown to reduce microvascular anastomosis flow and patency rates. Therefore, NRT should be avoided in microvascular free flap patients.