Smoking is a well-established risk factor for delayed wound healing and postoperative complications. Due to the overwhelming evidence of the detrimental health effects of smoking electronic cigarettes have become increasingly popular. The technology behind the devices has improved since their arrival in the UK and their use has been supported and encouraged by Public Health England; who stated they were 95% safer than smoking tobacco. But recent reports show a worrying link with serious respiratory illness and research has found that the nicotine, flavourings and diluents used in the e-cigarette fluids can have similar effects as tobacco on wound healing by increasing the risk of skin flap necrosis and hypoxia, with detrimental changes to the immune cells which aid healing. The recommendation is that patients should not be advised to use e-cigarettes as an alternative to conventional cigarettes prior to elective surgery.