Effect of cigarette smoking upon the finger circulation in normal and diabetic subjects

The association between tobacco smoking and systolic toe pressures in active foot ulceration

Smoking may increase the risk of diabetic foot disease and ulceration. It does so by impairing glycaemic control and promoting the formation of advanced glycated end-products. Additionally, smoking is known to delay surgical wound healing and accelerate peripheral arterial disease. We aimed to determine whether toe pressures differed in smokers with a foot ulcer, when compared to non-smokers and ex-smokers, as well as ulcer outcomes at 12 months, among patients attending Blacktown Hospital High Risk Foot Service (HRFS). This study is a retrospective analysis of our prospectively collected clinic database. Eligible participants were adults attending the HRFS between June 2020 and April 2022. Participants were included if they had an ulcer, at least one systolic toe pressure reading completed at their initial visit and attended at least one follow-up visit. Participants were followed until healing, loss to follow-up or a minimum of 12 months. A total of 195 participants were included; 36 smokers, 82 ex-smokers, and 77 controls who had never smoked. Smoking status was by self-report. Current smokers were significantly younger at initial presentation (p = .002) and tended towards lower socioeconomic status (p = .067). Current smokers were significantly more likely to have ischaemic grade 3 toe pressures (< 30 mmHg) of their left foot (p = .027), suggestive of reduced perfusion. At the end of follow up period, smokers had the numerically highest rates of minor amputations. In conclusion, smokers ulcerate younger and are more likely to have grade 3 ischaemia. Collecting information about the brachial artery pressures and the time since the last cigarette may clarify any relationship between smoking and toe pressures.Trial registration: WSLHD HREC ethics approval 2111-02 and ANZCTR registration 382470. Registered on 15/09/2021.

Review of the role of cigarette smoking in diabetic foot

Diabetic foot ulceration has been a serious issue over the past decades in Asia, causing economic and social problems. Therefore, it is important to identify and reduce the risk factors of diabetic foot. Cigarette smoking has been reported to be associated with diabetes and its macrovascular complications, but the relationship between smoking and diabetic foot ulcers is still unclear. In the present review, we summarize the effects of cigarette smoking on diabetic foot ulcers with respect to peripheral neuropathy, vascular alterations and wound healing. One underlying mechanism of these impacts might be the smoking-induced oxidative stress inside the cells. At the end of this review, the current mainstream therapies for smoking cessation are also outlined. We believe that it is urgent for all diabetic patients to quit smoking so as to reduce their chances of developing foot ulcers and to improve the prognosis of diabetic foot ulcers.

Cutaneous manifestations and consequences of smoking

Cigarette smoking is strongly linked to serious internal diseases such as cancer, cardiovascular disease, and lung disease. However, the external manifestations and consequences of smoking are relatively unknown. Although generally less ominous, the cutaneous manifestations of smoking may be associated with significant morbidity. This article reviews the known adverse effects on the skin of smoking.

Acute effects of smoking on digital artery blood flow in humans

Smoking induces several immediate physiologic changes in the distal arteries of the human upper extremity. We examined the hemodynamic effects of cigarette smoking on blood flow in normal human digital arteries using 20 MHz pulsed ultrasonic Doppler velocimeter methods. In each of nine subjects, two presmoke measurements and six postsmoke measurements were collected over a 30-minute period. Maximum velocity and volumetric flow data were averaged. Although no statistical differences were present between presmoke and postsmoke variables, maximum velocity decreased 14% and volumetric flow decreased 60% in the first postsmoke measurement interval. These observations suggest that smoking produces increased vascular resistance in the fingers and an overall reduction in both volumetric blood flow through arteries and tissue perfusion.

Effects of tobacco smoke inhalation on capillary blood flow in human skin

To measure the effects of tobacco smoke inhalation on capillary blood flow in human skin, 20 female tobacco smokers consented to smoke three cigarettes with nicotine levels of 0.50, 0.98, and 1.90 mg per cigarette, each on a separate occasion. Measurements of blood flow velocity and vascular diameter were made along the venous limb of capillaries within the nailfold skin of the third finger via videomicroscopy before and for 5 min after the smoking of each cigarette. Capillary blood flow (CBF) was calculated as a product of capillary cross-sectional area and flow velocity. Resting pre-smoke CBF for all experiments combined averaged 4.7 X 10(4) mu 3/sec. All three cigarettes elicited a significant reduction in CBF with the maximal effect within the first 2 min of the post-smoke period (p less than or equal to .05). Respective CBF values during this time averaged 3.6, 3.4, and 2.7 mu 3/sec for the low-, medium-, and high-nicotine cigarettes. Although the data suggested a downward trend in CBF with increasing nicotine levels, the post-smoke values were not significantly different among the three cigarettes. It is concluded that acute tobacco smoke inhalation reduces CBF in human skin, but the effect is not related to the nicotine content of the cigarettes. The changes in cutaneous CBF observed with tobacco smoking are less compared to reported effects of smoke inhalation on total digital blood flow.