Smoking and Foot Surgery

It is common knowledge that smoking cigarettes is bad for your health. There are so many statistics on smoking leading to cancers and other serious health conditions. So, we do not need to discuss the specifics of the link between smoking and poor health here, but do not forget about all those health problems that smoking will cause! However, why would you need to quit smoking if you are just having foot or ankle surgery? You will only be in the hospital for probably less than half the day, and you know that you can definitely go that long without having a cigarette, so what is the problem?

This is one aspect of the harm of cigarettes that has not been taught to the public over and over again like the other health issues that smoking causes.

When most people think of wounds, the first thing that comes to mind is being in an accident or suffering from a gunshot wound. However, the site of surgery also is classified as a wound, even though the surgeon is extremely careful with placement of incision and throughout the procedure. With this being said, smoking has a drastically negative impact on the body’s ability to heal a wound. How though?

The toxins in cigarettes cause tissue hypoxia. Tissue hypoxia means that the tissues are not getting enough oxygen, which is key to not only heal, but also necessary to maintain healthy tissue. One study found that smoking for 10 minutes will diminish the amount of oxygen distributed to the all the tissues in the body for up to one hour. However, if someone smokes one pack of cigarettes per day, the body’s tissues will go without sufficient oxygen for the entire day! Not only does smoking deprive tissues from their needed oxygen, but the toxins also cause the blood vessels to constrict, which will decrease blood flow to the skin and other tissues, which leads to a direct decrease in oxygen and necessary nutrients for both healing and maintenance of tissue. These are the two most important reasons for having a patient quit smoking prior to having surgery. Other problems that smoking causes regarding the healing and recovery process are:

  • Depletes the body’s supply of Vitamin C:  Vitamin C is an important factor in the formation of new tissues, such as collagen, skin and blood vessels.
  • Leads to a larger and more obvious scar: It has already been addressed that smoking causes a decrease in the body’s ability to maintain healthy tissue, which applies to the skin. The skin needs to be durable enough to be pulled together with sutures; however, if the skin is not durable the incision will not be held tightly together leading to a wider scar forming.
  • Causes skin grafting to fail: A skin graft is used in some surgeries if there is not enough skin available in the area to perform the procedure. This is usually performed by taking skin from somewhere else on the body and placing it on the foot or ankle where more skin is needed. However, smoking often times causes the skin graft to not “stick” since there is inadequate blood supply, oxygen, and necessary nutrients.

All surgeons have a requirement that a patient must be cigarette-free both before and after surgery, but that window of time varies between specialties. It is most ideal to quit smoking forever, in order to prevent any possible delayed wound healing, in addition to protecting yourself from more severe and serious health problems, such as cancer.

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