SRS317 - The impact of electronic cigarettes on Plastic and Reconstructive Surgery—A PRISMA systematic review

Abstract Background 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. Aims 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. Methods 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. Results 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. Conclusions Despite limited direct evidence, the physiological effects of vaping indicate potential harm. E-cigarette usage should be considered a modifiable perioperative risk factor, with screening and counselling advised. Until stronger data emerges, vaping should be managed with the same caution as smoking.