Answer:
In the 1994 article titled, "The effect of smoking on muscle transposition," the authors evaluated over 1000 muscle flap procedures and compared the complication rate between nonsmokers, previous smokers (pts with a 10 pack-yr history but none in the last year), and active smokers at the time of surgery. Active smokers were shown to have a complication rate significantly higher in the immediate post-operative period compared to non-smokers or previous smokers. The most common complication seen was partial muscle necrosis in 15% of active smokers. This occurred at more than double the incidence seen in non-smokers and previous smokers. The rate of complete muscle necrosis was comparable in all three groups suggesting that it is attributable to compromise of the vascular pedicle, rather than due to smoking. Partial skin graft loss requiring debridement and repeat grafting was increased in the group of active smokers. The infection rate was also elevated among smokers, while the seroma and wound dehiscence were comparable in all three groups. In short, active smoking at the time of muscle transposition significantly increases the risk of partial muscle necrosis and partial skin graft loss.