Background:
Worldwide, more than 1.1 billion people are tobacco smokers. Smoking tobacco is known to cause severe health effects, including cancer, cardiovascular and respiratory diseases, and it is one of the main causes of preventable death. It seems to be also one of the major risk factors for vascular alteration of the microcirculation.

Objectives:
The aim of this study was to evaluate the influence of smoking on hand microsurgery.

Methods:
PubMed and Cinahl were searched until November 2019. English full-text studies that investigated the relationship between smoke exposure and the onset of post-microsurgery complications of the hand, in adults, were included. Any type of study design was considered.

Results:
Only 15 studies out of 371 met the inclusion criteria. From a preliminary analysis of the results reported by the studies included in this review, it was possible to summarize smoking effects in 3 macro-areas: 1) effect of smoke on the microvascular flow (78%) in particular vasoconstriction of the vessel, slowing of blood flow and reduced tissue perfusion; 2) smoking-related post-operative complications (64%) mainly regarding wound healing and infections; 3) failure of hand microsurgery procedure (12%).

Conclusions:
Exposure to tobacco smoke pre- and post-microsurgery of the hand seems to be associated with high increase in the risk of post-operative complications. Quitting smoking at least 4 weeks before surgery is strongly recommended.