Ian A. Maher, MD Department of Dermatology St Louis University, St Louis, Missouri

Past and Present Smoking Raises Risk of Dermatology Surgery Complications

MedicalResearch.com Interview with:

Ian A. Maher, MD Department of Dermatology St Louis University, St Louis, Missouri

Dr. Maher

Ian A. Maher, MD
Department of Dermatology
St Louis University, St Louis, Missouri 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: One of our wonderful trainees at Saint Louis University was interested in the role of smoking in flap failures.  Dogma has been that smoking was a major risk factor for flap failures.  Looking at our database as well as published data, flap failures are a rare event, so rare as to be difficult to definitively associate with anything.  We decided to look more broadly at complications both acute (infections failures) and chronic (mainly cosmetic scarring associated) in flaps and grafts.

MedicalResearch.com: What should readers take away from your report?

Response: Cutaneous flaps and grafts are safe procedures with a low rate of complications irregardless of smoking status.  However, both current, and to a lesser extent former, smokers have a significantly increased rate of adverse effects.  The vast majority of those are cosmetic scarring related, and our data reinforces the need to counsel these patients pre-surgery on the possibility of requiring a post-surgical revision to improve the cosmetic result.  Again in the vast majority of cases in our series, that revision was simply intralesional steroid injections. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: Our study was retrospective and thus has the inherent limitations of all retrospective research.  Prospective research as to the role of smoking status, as well as interventions such as antioxidant therapy to decrease AE in smokers are warranted.

No disclosures. 


Wang CY, Dudzinski J, Nguyen D, Armbrecht E, Maher IA. Association of Smoking and Other Factors With the Outcome of Mohs Reconstruction Using Flaps or Grafts. JAMA Facial Plast Surg. Published online June 13, 2019. doi:10.1001/jamafacial.2019.0243

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Last Updated on June 14, 2019 by Marie Benz MD FAAD