• J Hand Surg Am · May 2018

    The Effect of Electronic Cigarettes on Hand Microcirculation.

    • Matthew J Pywell, Matthew Wordsworth, Richard M Kwasnicki, Priyanka Chadha, Shehan Hettiaratchy, and Tim Halsey.
    • Imperial College Healthcare NHS Trust, London, United Kingdom. Electronic address: mjpywell@gmail.com.
    • J Hand Surg Am. 2018 May 1; 43 (5): 432-438.

    PurposeSmoking conventional cigarettes reduces peripheral microcirculation leading to worse outcomes after hand surgery. Patients are increasingly using electronic cigarettes (eCigarettes); however, there is no published research investigating the effects of eCigarettes on hand microcirculation.MethodsFifteen healthy subjects with a median age of 26 years were recruited: 7 smokers and 8 nonsmokers. A noninvasive O2C laser Doppler probe measured a baseline control reading at deep (7-mm) and superficial (3-mm) levels. Participants commenced a 5-minute smoking protocol of nonnicotine (0-mg) eCigarettes with continuous microcirculation measurements during smoking and for 20 minutes afterward. This was repeated with nicotine (24-mg) eCigarettes. Readings were averaged over 5-minute periods and standardized as a percentage of baseline. A linear mixed-effects model with an unstructured covariance structure was used to analyze the data.ResultsSmokers had a statistically significant reduction in hand microcirculation during and up to 20 minutes after smoking a 24-mg eCigarette. There was a maximum reduction of 77% in superficial flow and 29% in deep flow. After smoking a 0-mg eCigarette, smokers demonstrated an increase in superficial flow of up to 70% with no change in deep flow. Nonsmokers had no statistically significant change in superficial or deep flow after smoking either eCigarette.ConclusionsA 24-mg eCigarette significantly reduced smokers' hand microcirculation during and after smoking. Microcirculation increased in smokers after inhalation of a 0-mg eCigarette.Clinical RelevanceWe advise smokers undergoing hand surgery to avoid high-dose eCigarettes and, if necessary, to use 0-mg eCigarettes as an alternative.Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

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