Health Matters: Cigarettes make healing difficult

Conway McLean, DPM, Journal columnist

At this point, most adults know that smoking cigarettes is bad for you. This statement is no longer controversial as it once was. An advertisement from the 1950’s featured a physician, sitting amongst his charts, wisely commenting on the health benefits of cigarettes while cooly smoking away. When asked, lung cancer is listed as the biggest concern for those individuals who “choose” to smoke on a regular basis. But there are many others, some of them surprising.

Although most Americans know there are dangers, the use of tobacco products continues. Roughly a fifth of the American population consumes some kind of tobacco product on a fairly regular basis. There’s no question the consequences to one’s respiratory system can be significant, with cigarette use linked to the great majority of all cases of lung cancer, approximately 85%.

The statistics reveal more than 16 million Americans have a smoking-related disease, from the aforementioned cancer risk to chronic obstructive pulmonary disease (COPD), from emphysema to asthma. In fact, it is the leading cause of preventable death, with almost half a million Americans dying each year in the U.S. as a result of smoking. One out of ten U.S. citizens state they have a dependence on a tobacco product. This equates to a high incidence of lung disease and the associated disability.

There are numerous effects to one’s health when using tobacco products. These include organ systems well beyond the respiratory (lungs). Smoking has been shown to harm almost every single organ in the body, from lung tissue deep inside, through to our outermost layer, the skin. Chronic and repeated exposure to cigarette smoke results in dangerous changes, to various tissues, throughout the body.

Cigarette smoking is linked to a higher incidence of cardiovascular disease and stroke. Many are unaware it makes them more prone to developing diabetes. Immune dysfunction is another common result, meaning someone has a reduced ability to fight infection. And the positive ions in smoke cause premature aging of the skin, along with reduced soft tissue health.

To a physician treating the lower extremity, the most significant of these effects concerns this latter item, tissue health. Research has uncovered a strong correlation between smoking and thin, unhealthy skin, as well as the soft tissues under the skin. One consequence is impaired wound healing. Studies demonstrate numerous reasons for this phenomenon, one being quite predictable.

Smoking essentially narrows blood vessels, slowing the supply of oxygen and nutrients to your tissues, especially those of the lower leg. These structures are farther from the heart, so they are deprived of the vital substances in freshly oxygenated blood more than any other. An adequate supply of oxygen is necessary for all living cells. When there is an injury to any tissue, healing requires increased production of the injured cell type, meaning even more oxygen and nutrients are needed. Less oxygen means more cells will die, increasing the amount of dead tissue in a wound. Additionally, your red blood cells are carrying more toxic chemicals and less oxygen if you smoke.

When you have a skin injury, you need your immune system to kill the bacteria which will invariably attempt to “set up shop.” Smoking reduces the effectiveness of the cells composing your immune system. Because these cells help protect the body from bacteria, any opening in the skin has a greater risk of developing an infection. Further, cigarettes reduce the amount of any antibiotics carried to the infected area.

The increased risk of reduced healing should be of particular concern for the cigarette smoker with diabetes. This all-too-common disease is well recognized to slow healing all by itself, needing no added limitations. These individuals already have a higher incidence of arterial disease in the lower leg. The result, when added to the numerous factors associated with tobacco use, is an even higher risk of complications, like infection, hospitalization, and amputation.

Surgery has become somewhat mythicized in popular culture, the solution to numerous medical conditions. But surgery entails trauma to the human body, so tissue injury is involved, and this requires healing. And smokers have a higher incidence of unsatisfactory healing after many operations, especially plastic or reconstructive procedures. To completely prevent any and all risk from cigarette use prior to surgery, the studies say one full year of abstinence is required. (And how likely is that?)

The mechanism for these problems is multi-faceted, but nicotine is a primary player. This component of tobacco causes blood vessel constriction, reducing blood flow as mentioned, interfering with the transportation of oxygen and nutrients. Simultaneously, nicotine increases the clotting of platelets, the cells which clump together to seal the end of a leaking, injured artery. Nicotine also reduces the production of several cell types that are vital components of our blood. Adding insult to injury, carbon monoxide is produced in the act of burning tobacco, diminishing further oxygen transport and metabolism.

Most individuals can list some relative or acquaintance who lived into their later years and “smoked like a chimney.” There are always exceptions to the rule, and no one will guarantee any of these aftereffects of smoking. But a typical “pack-per-day” smoker experiences reduced oxygen in his tissues, referred to as tissue hypoxia, a significant portion of their day. This degree of hypoxia is associated with poor wound healing in both animal and human studies. It’s all about the odds; if you smoke long enough, chances are good you will suffer some of these consequences. So you have to ask yourself, Mr. or Ms. Smoker….are you feeling lucky?

EDITORS NOTE: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at drcmclean@penmed.com.


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