Does systemic isotretinoin inhibit healing in a porcine wound model?

Within the plastic surgery community, it is widely believed that waiting a minimum of 6 to 12 months after patient cessation of systemic retinoid therapy is necessary before proceeding with elective surgery.

The authors investigate partial- and full-thickness wound healing after treatment with systemic isotretinoin in a porcine model.

Following institutional approval, 2 Hanford miniature pigs were obtained. One pig received isotretinoin at a dose of 2 mg/kg/d, administered orally along with pig feed over a 60-day period; the other (control) pig received only pig feed over the same time period. After the treatment period ended, a total of 24 full-thickness wounds and 24 partial-thickness wounds were made on each pig. The wounds were evaluated by photographic and histological analysis at 7, 14, and 28 days.

The average full-thickness wound size in the control animal was 0.4346 cm(2) at 14 days and 0.0689 cm(2) at 28 days. The average full-thickness wound size in the isotretinoin-treated animal was 0.4685 cm(2) at 14 days and 0.0363 cm(2) at 28 days. The differences were not statistically significant between the 2 animals at either time point. On histological analysis, the healing characteristics of partial- and full-thickness wounds were similar at 7, 14, and 28 days for both animals.

Invasive surgery might be safely performed even in the presence of recent isotretinoin therapy. This finding challenges the current practice of waiting longer than 6 months after completion of therapy to perform surgery.