Clinical and experimental studies of cigarette smoking in microvascular tissue transfers.

Circulatory crisis, attributed to cigarette smoking, in three microvascular cases (two toe transfers, one musculocutaneous flap) is reported. After anticoagulation and antispasm treatment only one transfer survived. Coordinated experimental studies in the rat demonstrated that cigarette smoking delayed anastomotic healing. Five days after anastomoses were performed, endothelial cells completely covered the sutures in the experimental smoking group in only 16-19% of sutures, while the control group had a 75% coverage rate. Mechanisms and characteristics of circulatory crisis caused by cigarette smoking are discussed.