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Nikotinkonsum und plastische Chirurgie

Eine aktuelle Übersicht

Nicotine in plastic surgery

A review

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Zusammenfassung

Hintergrund

Die chirurgische Komplikationsrate wird durch aktives Rauchen dramatisch erhöht. Dennoch existieren keine allgemeingültigen Richtlinien zur Durchführung elektiver plastisch-chirurgischer Eingriffe bei aktiven Rauchern.

Methoden

Es wurde eine Medline-Analyse der publizierten klinischen und experimentellen Arbeiten von 1965 bis 2008 durchgeführt.

Ergebnisse

Bei Faceliftoperationen tragen Raucher ein 13fach erhöhtes Risiko für die Entwicklung von Hautnekrosen gegenüber Nichtrauchern. Bei Mammareduktionsplastiken ist neben der Anzahl der Komplikationen (Odds ratio [OR] 2,1) die Häufigkeit von Nekrosen im Bereich des T-Schnitts (OR 3,1) und die Infektionsrate (OR 3,3) signifikant erhöht. Der Eigengewebeaufbau der Brust mit dem Transverse-rectus-abdominis-myocutaneous-Lappen zeigt bei Raucherinnen eine signifikant höhere Lappennekroserate als bei Nichtraucherinnen (19% vs. 9%, p=0,005). Der Cotinine-Test ermöglicht die quantitative Erfassung eines Nikotinkonsums bis zu 4 Tage vor dem Test.

Schlussfolgerung

Vier Wochen Nikotinkarenz kann die raucherassoziierten Komplikationen bei elektiven plastisch-chirurgischen Eingriffen senken. Trotz der bekannten nachteiligen Wirkungen des Rauchens erfolgen plastisch-chirurgische Eingriffe bei aktiven Rauchern. Die Komorbidität durch aktives Rauchen wird allerdings im DRG-System 2008 nicht länger erlössteigernd erfasst.

Abstract

Background

The surgical complication rate is significantly increased in active smoking patients. However there are no evidence-based recommendations regarding smoking among patients seeking plastic surgical procedures.

Methods

MEDLINE analysis was performed of all relevant clinical and experimental papers from 1965 to 2008.

Results

In face-lift operations smokers present a 13-fold risk of skin necrosis. In mamma reduction procedures the risk among smokers is doubled for number of complications, with T-incision site necrosis (odds ratio 3.1) and infection rate (OR 3.3) significantly elevated among active smokers. Transverse rectus abdominis myocutaneous flaps for breast reconstruction are associated with significantly higher flap necrosis rates for smokers than nonsmokers (19% vs 9%, P=0.005). The smoking history can be indicative, but usually the number of cigarettes is drastically underestimated. Cotinine testing is a method of determining smoking quantitively up to 4 days before testing.

Conclusion

Four weeks of abstinence from smoking reduces smoking-associated complications. Despite the published evidence, smoking is no longer relevant in the German 2008 Disease-Related Group for plastic surgical procedures.

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Authors and Affiliations

  1. Plastische, Hand und Wiederherstellungschirurgie, Med. Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland

    K. Knobloch, A. Gohritz, E. Reuss & P.M. Vogt

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  1. K. Knobloch
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  2. A. Gohritz
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  3. E. Reuss
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  4. P.M. Vogt
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Correspondence to K. Knobloch.

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Knobloch, K., Gohritz, A., Reuss, E. et al. Nikotinkonsum und plastische Chirurgie. Chirurg 79, 956–962 (2008). https://doi.org/10.1007/s00104-008-1561-3

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