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Electronic Cigarettes Are As Toxic To Skin Flap Survival As Tobacco Cigarettes.
Aline S. Rau, M.D., Viktorija Reinikovaite, BS, Joshay Ford, BS, Eric Schmidt, MD, Laima Taraseviciene-Stewart, PhD, Frederick W-B Deleyiannis, MD, MPhil, MPH.
University of Colorado, Denver, CO, USA.

PURPOSE:
Electronic cigarettes (e-cigarettes) have become increasingly popular. However, information about the health risks associated with vaping is sparse. There are currently no published studies examining the effects of e-cigarettes on microcirculation or perfusion. Using a rat skin flap model, we examined the toxic effects on microcirculation and perfusion e-cigarettes may have in comparison with tobacco cigarettes.
METHODS:
60 rats were divided into a room air group, a tobacco cigarette smoke exposure group, a medium-nicotine content (1.2%) e-cigarette vapor exposure group, and a group exposed to a high-nicotine content (2.4%) e-cigarette vapor. After 20 days of exposure, a random pattern, 3x9 cm skin flap was elevated on the dorsum of the rats. At 25 days of exposure, flap survival was evaluated digitally, and the rats were euthanized. Plasma was collected for nicotine and cotinine analysis, and flap tissues were harvested for histopathological and biochemical assays.
RESULTS:
Digital evaluation of the dorsal skin flaps demonstrated significantly increased necrosis in the vapor and tobacco groups. The average necrosis within the groups was as follows: control 18.0%, high-dose vapor 28.6%, medium-dose vapor 35.9%, and tobacco cigarette 30.1%. While the e-cigarette and tobacco cigarette groups did not differ significantly, each individual group had significantly more necrosis than the control group (p<0.05).
CONCLUSION:
Both the medium and high-nicotine content e-cigarette exposure groups have similar amounts of flap necrosis when compared to the tobacco cigarette exposure group. Nicotine-containing e-cigarette vapor may be just as toxic to skin flap survival as tobacco cigarettes.


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