Lessons Learned: A Disruption in Care Leads to Increased Rates of Proximal Amputations.

BACKGROUND: In March 2020, due to the COVID-19 pandemic, hospitalizations in New York state were restricted to emergency purposes. Non-COVID related cases involving lower extremity wounds were only admitted for acute infections and limb salvage. Patients with these conditions were placed at higher risk for eventual limb loss. PURPOSE: To understand the impact of COVID-19 on amputation rates. METHODS: A retrospective review of lower limb institution-wide amputations was conducted at Northwell Health from January 2020 to January 2021. The amputation rates during the COVID-19 shutdown period were compared to the pre-pandemic, post-shutdown, and reopening period. RESULTS: The pre-pandemic period had 179 amputations, of which 8.38 % were proximal. 86 amputations were performed during shutdown, with a greater proportion being proximal (25.58 %, p=0.0009). Following the shutdown period, amputations returned to baseline. The proportion of proximal amputations during post-shutdown was 18.5 % and during reopening was 12.06 %. Patients had 4.89 times higher odds of undergoing a proximal amputation during the shutdown period. CONCLUSIONS: The effect of COVID-19 on amputation rates demonstrates an increase in proximal amputation during the initial shutdown. This study suggests an indirect negative effect of COVID-19 hospital restrictions on surgeries during the initial shutdown period.

Chronic venous insufficiency: a comprehensive review of management.

Chronic venous insufficiency is an extensive progressive disease in need of public health attention. This insidious disease is a growing burden on patient quality of life and the health economy. Chronic venous insufficiency has become more pronounced in global populations, especially in regions exhibiting a higher rate of risk factors. It is critical for healthcare providers to recognise and intervene early to prevent ongoing and debilitating complications. This article provides a comprehensive review of chronic venous insufficiency outlining the anatomy, pathophysiology, clinical presentation, assessment and management options.

Virtual Events in the Era of COVID-19: Perspectives From a Virtual Interdisciplinary Wound Care Symposium.

BACKGROUND: The coronavirus disease-19 pandemic has created changes in the way medicine is practiced. The move to virtual conferencing to avoid mass gatherings is a significant change to how health care professionals meet, discuss current trends, and share research. METHODS: Data from exit polls conducted after annual wound care symposiums were reviewed. Physicians, nurses, podiatrists, and other health care professionals attended. Respondents were asked to comment and reflect on their experiences of attending a virtual conference. RESULTS: Over 60% of all (N = 283) respondents stated the virtual conference was better than or on par with a live event. Many respondents had attended this live event in person in previous years. Of all respondents, 83% stated that they planned to access conference materials for the 30 days they remained posted after the event. More than 50% of respondents stated they favored the ability to communicate effectively with colleagues via the instant messaging feature offered by the conference. Approximately 80% of respondents stated that they would like to attend this and other conferences virtually in the future. CONCLUSIONS: The shift from in-person to virtual conferences has the potential to remain a significant method of attending health care conferences. Conference organizers are encouraged to consider how they can implement virtual components, including postconference access to materials, to enhance the conference experience. Additional work needs to be done to understand the impact of the virtual format on knowledge retention.

Pedal gangrene in a patient with COVID-19 treated with prone positioning and extracorporeal membrane oxygenation.

Many patients hospitalized with coronavirus disease 2019 are treated with venovenous extracorporeal membrane oxygenation and prone positioning to optimize oxygenation. However, this combination can result in lower extremity tissue necrosis, especially without adequate offloading. We report the case of a 31-year-old man who required mechanical ventilation and venovenous extracorporeal membrane oxygenation secondary to complications from coronavirus disease 2019, and subsequently developed pedal dry gangrene. The patient was discharged and healed without requiring an amputation. Our institution has since revised the prone positioning protocol to address offloading the lower extremities and feet.

Wound care during the COVID-19 pandemic: improving outcomes through the integration of telemedicine.

COVID-19 is highly contagious and its rapid spread burdens the healthcare system. As the number of confirmed cases goes up, the shortage of medical resources has become a challenge. To avoid the collapse of the healthcare system during the fight with COVID-19, all healthcare workers, including wound care practitioners, should adapt to new roles and use any appropriate methods available to slow the spread of the virus. Integrating telemedicine into wound care during the outbreak helps maintain social distancing, preserve personal protective equipment and medical resources, and eliminate unnecessary exposure for both vulnerable patients and high-risk healthcare workers.

Cutaneous Manifestation During COVID-19: Don't Let the Rash Fool You

Boyar and Oropallo discuss that cutaneous manifestation in time of COVID-19. Kawasaki disease (KD) is a multisystem vasculitis and a mucocutaneous lymph node syndrome that occurs primarily in young children with a potential of life-long coronary artery and cardiac disease. Multisystem inflammatory syndrome in children (MIS-C) is a new syndrome that shares many similarities with KD, but age and prominent clinical manifestation show some differences. Myocardial involvement with acute heart failure, shock, and multi-organ failure are feared sequalae. One of the challenges of working in an outpatient wound center is identifying SARS-CoV-2 lesions without obvious symptomatology.