Smoking increases facial skin flap complications

This study was undertaken to determine whether smokers have a higher risk o f complications after reconstruction of facial skin defects. Ninety-one pat ients with facial skin defects reconstructed with local flaps were reviewed retrospectively. Thirty-eight (42%) were active smokers, 12 (13%) had not smoked for at least 1 year prior to surgery? and the rest were nonsmokers. Complications occurred in 23 patients (25%; 37% in smokers, 17% in ex-smoke rs, and 17% in nonsmokers; p <.03). All full-thickness skin losses and all cellulitis occurred in active smokers. We conclude that active smokers are at a higher risk for complications in facial skin flap surgery. That ex-smo kers had a complication rate similar to that of nonsmokers suggests that pa rt of smoking's adverse effect on skin flaps may be an acute phenomenon, an d that smoking cessation for shorter (<1 year) periods of time before surge ry may have a beneficial effect.