isotretinoin and Postoperative-Complications

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.. 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.. 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.. 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.. 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.

Topics: Dermatologic Agents; Humans; Isotretinoin; Plastic Surgery Procedures; Postoperative Complications; Wound Healing

The thick-skinned nose is still one of the most challenging aspects of rhinoplasty. The possible effects of oral isotretinoin on cosmetic results of rhinoplasty in patients with thick nasal skin have been considered during recent years.. In this double-blind placebo-controlled clinical trial, 48 cases were divided into two groups randomly. Oral isotretinoin (0.5-mg/kg) was started on the 31st day after surgery and given every other day for 1 month and after that daily for two additional months in the first group. The second group received a placebo in the same form, sequence and interval as the first group. The cosmetic results based on patient satisfaction and ranking by an expert surgeon were compared between the two groups at 3 months, 6 months and 1 year after surgery.. Patient satisfaction and ranking by an expert surgeon in the isotretinoin group at 3 months and 6 months after surgery were significantly better than in the placebo group (p value < 0.05); however, at 12 months after surgery there was no statistically significant difference between the two groups (p value > 0.05).. Though postoperative use of oral isotretinoin in patients with thick nasal skin accelerates improvement in cosmetic results during the early months after surgery, it does not significantly affect the final cosmetic result 1 year after surgery.. This journal requires that 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 .

Topics: Administration, Oral; Adolescent; Adult; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Edema; Esthetics; Female; Follow-Up Studies; Humans; Isotretinoin; Male; Middle Aged; Nasal Septum; Nose Diseases; Postoperative Complications; Prospective Studies; Reference Values; Rhinoplasty; Severity of Illness Index; Skin; Time Factors; Treatment Outcome; Wound Healing; Young Adult

To determine whether postoperative oral 13-cis-retinoic acid (RA) treatment could improve the outcome of vitreoretinal surgery with silicone oil for the management of proliferative vitreoretinopathy (PVR).. Prospective controlled randomized interventional case series.. This study included 35 eyes of 35 patients with primary rhegmatogenous retinal detachment and PVR. All patients underwent surgical repair by similar procedures. The RA group consisted of 16 patients who received 10 mg oral RA twice daily for eight weeks postoperatively. The control group included 19 patients without taking RA. The outcome measure included the rate of retinal attachment, macular pucker formation, ambulatory vision, and RA-related side effects.. At last follow-up (at least one year postoperatively), 15 of 16 eyes (93.8%) in the RA group and 12 of 19 eyes (63.2%) in the control group maintained retinal attachment (P = .047). The rate of macular pucker formation was significantly lower in the RA group (18.8% vs 78.9% in the control group; P = .001). A higher rate of ambulatory vision was achieved in the RA group as compared to the control group (56.3% vs 10.5%; P = .009).. Postoperative administration with oral moderate dosage of RA for eight weeks appears to maintain retinal attachment, decrease the macular pucker, and improve vision after surgical repair for eyes with PVR.

Topics: Administration, Oral; Female; Follow-Up Studies; Humans; Isotretinoin; Laser Coagulation; Lens Implantation, Intraocular; Male; Middle Aged; Postoperative Complications; Prospective Studies; Recurrence; Retinal Detachment; Scleral Buckling; Silicone Oils; Treatment Outcome; Visual Acuity; Vitrectomy; Vitreoretinopathy, Proliferative

To determine the functional outcomes of laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) in patients taking isotretinoin, which is contraindicated for these procedures.. Multicenter, retrospective, interventional case series.. All patients taking isotretinoin who underwent LASIK or PRK from January 2003 to September 2017 were included (Group 1). Patients were compared with those undergoing LASIK or PRK who had taken isotretinoin previously but not in the previous 6 months (Group 2). Patients were included consecutively.. A total of 113 patients (219 eyes) were included. No significant intraoperative or postoperative complications were found. There were no significant differences between the groups in terms of visual acuity, postoperative spherical equivalent, efficacy index, predictability, or safety index. When only PRK patients were taken into account, the efficacy index (P = .017), postoperative sphere (P = .041), and postoperative astigmatism (P < .001) were better in Group 2, although the difference was not clinically relevant.. In our experience, LASIK and PRK can be performed effectively and safely in selected patients taking isotretinoin. The absolute exclusion of certain systemic medications should be reconsidered.

Topics: Acne Vulgaris; Adolescent; Adult; Astigmatism; Dermatologic Agents; Female; Humans; Intraoperative Complications; Isotretinoin; Keratomileusis, Laser In Situ; Lasers, Excimer; Male; Middle Aged; Photorefractive Keratectomy; Postoperative Complications; Retrospective Studies; Treatment Outcome; Visual Acuity; Young Adult

Topics: Cicatrix; Dermatologic Agents; Dermatologic Surgical Procedures; Humans; Isotretinoin; Perioperative Period; Postoperative Complications; Postoperative Hemorrhage; Retrospective Studies; Surgical Wound Dehiscence; Surgical Wound Infection; Time Factors; Wound Healing

Topics: Administration, Oral; Basal Cell Nevus Syndrome; Female; Humans; Isotretinoin; Keratolytic Agents; Middle Aged; Organ Transplantation; Postoperative Complications; Practice Guidelines as Topic; Retinoids; Risk Factors; Skin Neoplasms; Xeroderma Pigmentosum

Topics: Acne Vulgaris; Adult; Cyclosporins; Drug Interactions; Heart Transplantation; Humans; Isotretinoin; Male; Postoperative Complications