Purpose: Electronic cigarettes have become an increasingly popular tobacco cigarette substitute. Some perceive it as being less harmful and an effective method for perioperative nicotine replacement therapy. Microsurgery is especially susceptible to complications caused by traditional smoking which causes vasoconstriction, vascular occlusion, and tissue hypoxia. There is limited data on the effects of electronic cigarette usage in patients undergoing microsurgery. Methodology: In December 2023, a systematic literature search was conducted from database Medline, Embase and Cochrane according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The following search keywords were used: vaping, vape, e-cigarettes, electronic cigarettes, electronic nicotine delivery system, e-liquid, microsurgery, surgical flaps, free flap, free tissue transfer, plastic surgery, surgery. Results: 518 articles were screened, 21 papers were selected for full text review, out of which there were only 2 case reports presenting the complications due to electronic cigarette usage. Both free flaps survived but underwent vasoconstriction within 24 hrs postoperatively and one required a return to theatre for exploration. Other studies that were included for full text reviews only comprise animal or experimental studies that demonstrate the adverse effects of electronic cigarette on circulation and wound healing. Conclusion: This study posits that electronic cigarettes follow a similar complication profile to traditional cigarettes. The case reports would suggest vasoconstriction may be associated, but there is a paucity of evidence and further research needs to be undertaken in this area.