Impaired circulation reduces tissue perfusion. This slows healing and increases the risk of infection. Although tissue hypoxia stimulates angiogenesis (Knighton et ai, 1981), it impairs all metabolism and overall growth rate. Peripheral vascular disease is often a complication of diabetes mellitus. It has a detrimental effect on the healing of wounds on the lower limbs and may even be a precipitating factor.
Smoking causes vasoconstriction and is associated with Buerger's Disease, a condition causing intermittent claudication and gangrene. Moseley et al. (1978) suggested that smoking also interfered with the proliferation of erythrocytes, thereby reducing the available oxygen. A review of the effects of smoking on wound healing by Siana et al. (1992) found that nicotine affected macrophage activity and reduced epithelialisation and wound contraction. Jorgensen et al. (1998) found that smoking impedes collagen synthesis and recommended that patients be advised to stop smoking prior to surgery.
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