SRS317 - The impact of electronic cigarettes on Plastic and Reconstructive Surgery—A PRISMA systematic review
Abstract
Electronic cigarettes are increasingly used as alternatives to tobacco smoking, often perceived as less harmful and as cessation tools. Although they reduce exposure to some toxins, they still deliver nicotine and other biologically active compounds. Their effects on surgical outcomes, particularly in plastic and reconstructive surgery where wound healing and tissue perfusion are critical, remain unclear.
This PRISMA systematic review evaluated evidence on the impact of e-cigarette use on outcomes in plastic surgery, focusing on wound healing, flap viability, immune competence, and perioperative risk.
A systematic search of PubMed, MEDLINE and Embase was undertaken in July 2025 in accordance with PRISMA guidelines. Eligible studies included in vivo, ex vivo, case reports and basic science research relating to e-cigarettes and plastic surgery. Screening was performed by multiple reviewers, with disagreements resolved by discussion.
There is a paucity of high-quality clinical data. Case reports associate perioperative e-cigarette use with complications such as flap necrosis and wound dehiscence. Nicotine in e-liquids is linked to vasospasm, compromising flap viability. Animal studies suggest e-cigarette vapour impairs tissue viability in a manner comparable to tobacco smoke. Flavouring agents contribute to inflammation, oxidative stress and immune suppression, further jeopardising healing. Variable nicotine absorption and dual product use complicate risk assessment.
Despite…
How strong is the evidence?
Evidence Hub reads this as a systematic review. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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