Wound Healing Goes Down in Smoke: The Effects of Smoking on Wound Healing

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By Bruce E. Ruben MD

Today in 2014, there should be no question that tobacco use is one of the worst things you can do to your body. There have been hundreds of scientific studies. This subject is extremely well documented.

From the Centers for Disease Control and Prevention (CDC) alone:

  • Smoking harms nearly every organ of the body.
  • Smoking causes many diseases and reduces the health of smokers in general.
  • Smoking causes more than 480,000 deaths each year in the U.S. That’s about one in five deaths.
  • Cigarette smoking causes most cases of lung cancer.
  • Blockages caused by smoking can also reduce blood flow to your legs and skin.
  • Smoking damages blood vessels and can make them thicken and grow narrower. This makes your heart beat faster and your blood pressure go up. Clots also form.

The bullet points go on, but we can already see the connection between smoking and poor wound healing. Essentially, healing depends on the body’s ability to transport freshly oxygenated blood and nutrients to and from a wound site. If you’re smoking, you are basically de-oxygenating your blood and robbing the wound site of the oxygen it needs to heal. Worse, you’re replacing the fresh oxygen you would normally be breathing with a deadly mix of more than 7,000 chemicals, of which hundreds are toxic and about 70 can cause cancer.

How Smoking Impairs the Body's Ability to Heal Wounds

b._ruben_smoke1.jpgNutritionally, smokers tend to eat less healthfully, do fewer physical activities and consume more alcohol. All of these have an adverse effect on wound healing.

First, the body needs tremendous amounts of energy/calories to heal wounds. But since nicotine is a proven appetite suppressant, smokers have an increased potential to take in fewer calories, resulting in delayed or impaired wound healing.

The full physical effects from the newer e-cigarettes are not known, though the liquid nicotine they feature is certainly a poison and can be lethal. It can be harmful when inhaled and it can also be harmful when ingested or absorbed through the skin. In fact, less than one tablespoon of the e-cigarette liquid on the market may be enough to kill an adult, and as little as a teaspoon could kill a child.

And although liquid nicotine’s effects on wound healing are unclear at this time, the CDC is clear about nicotine dependence. Nicotine is the drug in tobacco products that produces dependence and most smokers are dependent on nicotine.

Educate Your Patients About Smoking and Their Wounds

As wound care professionals, we must continue to educate our patients about the connection between smoking and poor wound healing. Smoking can either cause or exacerbate the five underlying conditions that inhibit wounds from healing: poor circulation, infection, edema, poor nutrition and repetitive trauma.


About the Author
Dr. Bruce Ruben is the Founder and Medical Director of Encompass HealthCare, located in West Bloomfield, Michigan. Encompass Healthcare is an outpatient facility featuring advanced wound care, IV antibiotic therapies, hyperbaric oxygen treatment, nutritional assessment, and other treatment modalities. Dr. Ruben is board certified in Internal Medicine, Infectious Disease, and in Undersea and Hyperbaric Medicine. He is a member of the Medical and Scientific Advisory Committee and National Spinal Cord Injury Association (NSCIA) board.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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