The influence of smoking on complications after primary amputations of the lower extremity.

A total of 165 primary above-the-knee (AK) and below-the-knee (BK) amputations in 137 patients were reviewed retrospectively. Of the 77 patients who smoked, 44 smoked cigarettes, 30 cheroots, and three a pipe. There were 88 nonsmokers. At the time of surgery, the smokers were on average 6.4 years younger than the nonsmokers. The review revealed no discrepancy between smokers and nonsmokers with regard to amputation level, the BK to AK ratio being 2:1. In cigarette smokers the risk of infection and reamputation was 2:5 times higher than in cheroot smokers or nonsmokers. The poor results obtained in cigarette smokers may be ascribed to the fact that this group of patients smoked during the phase of healing and that only cigarette smokers tend to inhale. Inhalation of smoke leads to high concentrations of nicotine, which compromise the cutaneous blood-flow velocity and increase the risk of the formation of microthrombi. Consequently, amputees should abstain from cigarette smoking during the phase of healing. Preferably, the habit should be broken one week before surgery, which is the requisite period for the process of coagulation and the fibrinogen level to normalize and for free radicals to be eliminated.