Most of my readers are unaware of the fact that, along with my specialty of pulmonary disease, I also have credentials in wound healing, and spend some clinical time in the wound clinic each week. My interest in wound care evolved from my interest and credentialing in Undersea and Hyperbaric Medicine. I see patients in consultation for hyperbaric treatments, which frequently are needed for specialized wound care.

One issue that frequently comes up in patients that have wounds that are not healing well is smoking. Tobacco smoke is a complex mixture of many ompounds, including nicotine, carbon monoxide, hydrogen cyanide, formaldehyde and benzene, to name just a few. Smokers have more wound healing omplications than patients who do not smoke.

The cause for the impairment in wound healing in smokers is multifactorial and includes constriction of the blood supply to the wound, a reduced inflammatory response needed to begin wound healing and a reduction in the normal bacteriocidal effects present in our tissues. These effects often lead to wound dehiscence, which is the opening of a wound after surgical closure. This can be seen in simple wounds such as those associated with hernia repair or larger wounds such as those related to open heart surgery.

Preoperative and postoperative smoking cessation can be helpful in reducing the risk of impaired wound healing. Unfortunately, nicotine replacement cannot be used in this circumstance since nicotine is one of the chemicals associated with vasoconstriction and poor wound healing