Does Systemic Isotretinoin Inhibit Healing in a Porcine Wound Model?

Background: 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. Objective: The authors investigate partial- and full-thickness wound healing after treatment with systemic isotretinoin in a porcine model. Methods: 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. Results: 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. Conclusions: 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.