title: Is It Safe to Operate on Patients Taking Isotretinoin?
abstract: BACKGROUND
  Oral isotretinoin is increasingly being used to treat acne and other dermatological conditions. The number of patients who take isotretinoin and wish or need to undergo plastic surgery may be following a similar pattern. Although skin healing is an important concern in the case of patients who use isotretinoin, it is definitely not the only relevant issue when planning surgical intervention.
  
  
  METHODS
  Eleven important points regarding surgery safety in patients taking oral isotretinoin were defined. A literature search of the PubMed database was conducted by employing the keywords isotretinoin OR 13-cis-retinoic acid. This returned the largest possible number of studies about isotretinoin.
  
  
  RESULTS
  Forty-seven studies matched the selection criteria. Most animal experimental models suggested that isotretinoin at doses commonly used to treat acne is not detrimental to wound healing. Human studies are controversial. However, healing of skeletal muscle could be at increased risk of necrosis.
  
  
  CONCLUSIONS
  Association between isotretinoin and problematic skin healing after surgery is being challenged. Also, recommended time between discontinuation of isotretinoin and surgery should be reviewed. While muscle flaps may be endangered in patients taking isotretinoin, healing of other tissues and systemic effects that could compromise surgery safety are rare or detectable before surgery.
  
  
  METHODS
  This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
authors.affiliation: Division of Plastic Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Campus Universitário S/N, 14048-900, Ribeirão Preto, SP, Brazil. lfungarelli@hotmail.com.
authors.forename: Luís Fernando
authors.initials: LF
authors.lastname: Ungarelli
authors.affiliation: Division of Plastic Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Campus Universitário S/N, 14048-900, Ribeirão Preto, SP, Brazil.
authors.forename: Cristina Marly Cunha
authors.initials: CM
authors.lastname: Hetem
authors.affiliation: Division of Plastic Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
authors.forename: Jayme Adriano
authors.initials: JA
authors.lastname: Farina Junior
mesh_terms: D003879:Dermatologic Agents / Q000009:adverse effects*; D006801:Humans; D015474:Isotretinoin / Q000009:adverse effects*; D011183:Postoperative Complications / Q000139:chemically induced*; D019651:Plastic Surgery Procedures; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D003879:Dermatologic Agents; D015474:Isotretinoin
keywords: 13-cis-retinoic acid; Isotretinoin; Safety; Surgery