Effect of nicotine treatment and withdrawal on random-pattern skin flaps in rats.

BACKGROUND Tobacco use is associated with a high incidence of skin necrosis after surgery. The ideal timing for the cessation of tobacco use before plastic surgery has not, however, been precisely determined. The aim of this work was to define the ideal duration of nicotine withdrawal prior to random-pattern skin flap surgery in rats. METHODS Groups of 11 animals were subcutaneously injected with saline or nicotine (2mg/kg) twice a day and subjected to random-pattern skin flap surgery according to the following protocol: Group I: continuously injected with saline 4 weeks before and 1 week after the surgery; Group II: injected with nicotine for 4 weeks until the day of the surgery; Group III: injected with nicotine for 4 weeks until one day before the surgery; Group IV: injected with nicotine for 4 weeks until 5 days before the surgery; Group V: injected with nicotine for 4 weeks until 10 days before the surgery; Group VI: continuously injected with nicotine for 4 weeks before and 1 week after the surgery. McFARLANE skin flaps were performed on the dorsal skin, and the rats were sacrificed 1 week after the surgery. RESULTS The necrotic area was smaller in group I (8.85cm2) than in group II (12.15cm2), III (12.88cm2) and VI (14.84cm2) (ANOVA p<0.0001). There was no difference between groups I, IV (10.13cm2) and V (9.27cm2). CONCLUSIONS In conclusion, 5 days before surgery was considered the ideal time for nicotine withdrawal in this experimental model.