The clinical effect of smoking on after tendon repair in smokers vs non-smokers was investigated, via exploring effects on flexor and tendon repair, and incidence of wound complications
Retrospective review of patients treated by 1 orthopedic surgeon, fellowship trained in hand surgery, and 3 occupational therapists working together in 1 physical therapy institution. 56 patients (20 smokers and 36 non-smokers) with acute traumatic tendon lacerations, fixed via direct (end-to-end) method, within 3 weeks from date of injury. Total Active Motion (TAM) was measured via American Society for Surgery of the Hand protocol.
Overall percentage of TAM regained in smokers was 70% vs 75% of TAM by non-smokers. No significant differences in TAM between smokers and non-smokers. Flexor tendon TAM was significantly higher in both the smoking and non-smoking groups vs extensors tendon TAM, displaying a larger effect of smoking on flexor vs extensor tendons. No significant dose dependent effect in “heavy” vs “light” smokers on numerous parameters. When grouping excellent, good and fair results, vs poor results, no significant difference exists, telling us tendon repairs universally do “poor” in terms of TAM, despite the fact if they are flexor or tendon repairs, and if the patient is a smoker or not. “Surgical wound complications”, were exceptionally low, 1 in the smokers, 2 in the non-smokers.
The main focus of the study was the clinical effect of smoking on digit ROM, and therefore functional capabilities after tendon repair. The authors anticipated decreased total active motion (TAM) in patients whom smoke. The anecdotal experience of the senior author with over 20 years of experience treating such tendon injuries, in smokers and non-smokers, is which lead this hypothesis. The incidence of wound complications in the patient population was investigated in regards to smokers and non-smokers. It was speculated the smoking group would have a statistically significant higher rate of wound complications. The authors believed both flexor tendons and extensor tendons will be equally affected by the biological effects of smoking.
Despite the undisputable harsh effects of smoking, it is scientifically inaccurate to claim patient post-operative range of motion in flexor and extensor tendon injuries is significantly affected by this unhealthy habit. Nor can we claim surgical site complications are more common in smokers in the setting of such injuries.