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Tobacco exposure and wound healing in head and neck surgical wounds
Author(s) -
Lassig Amy Anne D.,
Bechtold Joan E.,
Lindgren Bruce R.,
Pisansky Andrew,
Itabiyi Abayo,
Yueh Bevan,
Joseph Anne M.
Publication year - 2018
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.26813
Subject(s) - medicine , vascular endothelial growth factor , wound healing , prospective cohort study , cytokine , cohort , epidermal growth factor , scars , surgery , pathology , gastroenterology , vegf receptors , receptor
Objective Smoking impairs wound healing, yet the underlying pathophysiological mechanisms are unclear. We evaluated tobacco‐altered healing in head and neck surgery by studying the association between biomarkers and tobacco exposure, as well as cutaneous perfusion by smoking status. Study Design Prospective cohort study, tertiary/academic care center, 2011 to present. Methods Patients who required head and neck surgery were enrolled prospectively. Postsurgical drain fluid was collected 24 hours postoperatively. Biomarkers associated with postulated mechanisms of smoking‐impaired healing were assayed. These included interleukin‐1, ‐6, and ‐8; tumor necrosis factor‐ alpha; transforming growth factor‐beta; epidermal growth factor (EGF); basic fibroblastic growth factor (bFGF); C‐reactive protein; vascular endothelial growth factor; soluble FMS‐like tyrosine kinase‐1 (sFLT‐1); and placental growth factor. Tobacco exposure and clinical outcomes were recorded. Two sample two‐sided t tests evaluated the differences in cytokine levels by tobacco exposure. In a second cohort, cutaneous vascular assessment via indocyanine green angiography was compared by smoking status. Results Twenty‐eight patients were enrolled with drain fluid collection. Twenty‐one subjects were current/former smokers, whereas seven were never smokers. EGF was higher in never smokers than smokers in a statistically significant manner ( P = 0.030). Likewise, sFLT‐1 was significantly higher in never smokers ( P = 0.011). Cutaneous angiography revealed nonsmokers to have significantly higher cutaneous perfusion than smokers. Conclusion In this head and neck surgical cohort, significantly higher EGF and sFLT‐1 levels in wound fluid were associated with never smoking, suggesting that smoking has adverse effects on the inflammatory phase of wound healing. Cutaneous angiography supports the detrimental effect of smoking on skin perfusion. These findings suggest the need for further study as well as therapeutic targets for smokers undergoing surgery. Level of Evidence 2b. Laryngoscope , 128:618–625, 2018