WOUND HEALING IN OPEN AURICULAR WOUNDS IN SMOKERS: A NARRATIVE LITERATURE REVIEW

Smoking is associated with impaired tissue repair and a higher risk of postoperative wound complications. Open auricular wounds require particular attention because the pinna contains a thin soft-tissue envelope over cartilage, and injury severity depends on whether cartilage, perichondrium, or the vascularized skin envelope is disrupted. This narrative review discusses the biological effects of cigarette smoking on wound healing and considers how these mechanisms may be relevant to open wounds of the auricle. A focused narrative search was conducted using PubMed-indexed literature and reference-list checking, prioritizing reviews, meta-analyses, clinical studies, and anatomical reports concerning smoking, wound repair, and auricular injury. The evidence indicates that smoking can reduce tissue oxygenation, alter inflammatory-cell function, impair fibroblast migration and proliferation, and reduce collagen synthesis and deposition. Clinical meta-analysis has also associated smoking with increased risks of surgical-site infection, wound complications, delayed healing, and tissue necrosis. Auricular anatomy, however, should not be characterized as uniformly poorly vascularized: the skin receives arterial supply from the posterior auricular and superficial temporal systems with interconnections, whereas auricular cartilage itself is avascular and depends on surrounding tissues for nourishment. Direct clinical evidence specifically comparing healing of open auricular wounds in smokers and nonsmokers remains limited. Therefore, current recommendations for smoking cessation, careful assessment of cartilage involvement, atraumatic wound care, and surveillance for infection are supported mainly by broader wound-healing evidence and established auricular-trauma principles rather than auricle-specific comparative trials.