Electronic Cigarettes Are as Toxic to Skin Flap Survival as Tobacco Cigarettes

Ann Plast Surg. 2017 Jul;79(1):86-91. doi: 10.1097/SAP.0000000000000998.

Abstract

Purpose: Electronic cigarettes (e-cigarettes) have become increasingly popular. However, information about the health risks associated with e-cigarette use is sparse. Currently, no published studies examine the effects of chronic e-cigarette exposure on microcirculation or perfusion. Using a rat skin flap model, we examined the toxic microcirculatory effects e-cigarettes may have in comparison with tobacco cigarettes.

Methods: Fifty-eight rats were randomized to either exposure to room air, tobacco cigarette smoke, medium-nicotine content (1.2%) e-cigarette vapor, or a high-nicotine content (2.4%) e-cigarette vapor. After 4 weeks of exposure, a random pattern, 3 × 9 cm skin flap was elevated on the dorsum of the rats. At 5 weeks, flap survival was evaluated quantitatively, and the rats were euthanized. Plasma was collected for nicotine and cotinine analysis, and flap tissues were harvested for histopathological analysis.

Results: Evaluation of the dorsal skin flaps demonstrated significantly increased necrosis in the vapor and tobacco groups. The average necrosis within the groups was as follows: control 19.23%, high-dose vapor 28.61%, medium-dose vapor 35.93%, and tobacco cigarette 30.15%. Although the e-cigarette and tobacco cigarette groups did not differ significantly, each individual group had significantly more necrosis than the control group (P<0.05). These results were corroborated with histopathological analysis of hypoxic tissue.

Conclusions: Both the medium-content and high-nicotine content e-cigarette exposure groups had similar amounts of flap necrosis and hypoxia when compared with the tobacco cigarette exposure group. Nicotine-containing e-cigarette vapor is similarly toxic to skin flap survival as tobacco cigarettes.

MeSH terms

  • Animals
  • Disease Models, Animal
  • Electronic Nicotine Delivery Systems*
  • Graft Survival*
  • Male
  • Myocutaneous Flap / pathology*
  • Nicotine / toxicity*
  • Random Allocation
  • Rats
  • Rats, Sprague-Dawley
  • Surgical Flaps / pathology*
  • Tobacco Smoke Pollution / adverse effects*

Substances

  • Tobacco Smoke Pollution
  • Nicotine