*5.3.7 Smoking*

The detrimental impact of smoking on wound healing has been elegantly demonstrated nearly four decades ago by Mosely and Finseth in 1977 and re-assessed by Goldminz and Bennet in 1991 [54, 55].

The impact of smoking is multi-factorial: Nicotine has vasoconstriction properties that additionally decrease the proliferation of erythrocytes, macrophages, and fibroblasts - different cells that play indispensable role in wound-closure. Additionally, carbon monoxide severely limits the oxygen-carrying capacity of haemoglobin (thereby inducing tissue hypoxia) while simultaneously increasing platelet aggression and viscosity of blood and interfering with collagen deposition and prostacyclin formation [56].
