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1.
J Plast Reconstr Aesthet Surg ; 75(11): 4013-4022, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2048956

ABSTRACT

BACKGROUND: Microsurgery is a technically demanding aspect of surgery that is integral to a variety of sub-specialties. Microsurgery is required in high-risk cases where time is limited and pressure is high, so there is increasing demand for skills acquisition beforehand. The aim of this review was to analyse the available literature on validated microsurgical assessment tools. METHODS: Covidence was used to screen papers for inclusion. Keywords included 'microsurgery', 'simulation', 'end-product assessment' and 'competence'. Inclusion criteria specified simulation models which demonstrate training and assessment of skill acquisition simultaneously. Tools which were used for training independently of technical assessment were excluded and so were tools which did not include a microvascular anastomosis. Each assessment tool was evaluated for validity, bias, complexity and fidelity and reliability using PRISMA and SWiM guidelines. RESULTS: Thirteen distinct tools were validated for use in microsurgical assessment. These can be divided into overall assessment and end-product assessment. Ten tools assessed the 'journey' of the operation, and three tools were specifically end-product assessments. All tools achieved construct validity. Criterion validity was only assessed for the UWOMSA1 and GRS.2 Interrater reliability was demonstrated for each tool except the ISSLA3 and SAMS.4 Four of the tools addressed demonstrate predictive validity.4-7 CONCLUSION: Thirteen assessment tools achieve variable validity for use in microsurgery. Interrater reliability is demonstrated for 11 of the 13 tools. The GRS and UWOMSA achieve intrarater reliability. The End Product Intimal Assessment tool and the Imperial College of Surgical Assessment device were valid tools for objective assessment of microsurgical skill.


Subject(s)
Clinical Competence , Microsurgery , Humans , Reproducibility of Results , Microsurgery/methods , Anastomosis, Surgical/education , Computer Simulation
2.
J Plast Reconstr Aesthet Surg ; 75(1): 112-117, 2022 01.
Article in English | MEDLINE | ID: covidwho-1458637

ABSTRACT

INTRODUCTION: COVID-19 has disrupted the provision of breast reconstructive services throughout the UK. Autologous free flap breast reconstruction was restarted in our unit on 3 June 2020. We aimed to compare the unit's performance of microsurgical autologous breast reconstruction in the "post-COVID" period compared with the exact time period in the preceding year. METHODS: We retrospectively reviewed prospectively collected data in the "pre-COVID" (from 3 June 2019 to 31 December 2019) and "post-COVID" period (from 3 June 2020 to 31 December 2020). Patient demographics included age, body mass index, co-morbidities, Anaesthesiologists (ASA) grade and smoking status. Surgical factors included neoadjuvant chemotherapy, previous chest wall radiotherapy, unilateral or bilateral reconstruction, reconstruction timing, number of pedicles, contralateral symmetrisation and other procedures. dependant variables were ischaemic time, operative time, mastectomy weight, flap weight, length of stay, return to theatre and complication rates. The number of trainers and trainees present in theatre was recorded and analysed. RESULTS: Fewer DIEP flaps were performed in the "post-COVID" period (45 vs. 29). No significant difference was observed in mastectomy resection weight, but flap weight was significantly increased. No significant difference was found in ischaemic time as well. The postoperative length of stay was significantly reduced. No significant difference was found in rates of return to theatre, unplanned admission, infection, haematoma, seroma or wound dehiscence. No cases of venous thromboembolism or flap failures were recorded. The mean number of trainers and trainees, and the trainee-to-trainer ratio was not found to be significantly different between cohorts. CONCLUSION: Although fewer cases were performed, autologous breast reconstruction was safely delivered throughout the COVID-19 pandemic in the first wave without affecting training.


Subject(s)
Breast Neoplasms/surgery , COVID-19/epidemiology , Free Tissue Flaps/transplantation , Mammaplasty/methods , Microsurgery/methods , Female , Humans , Length of Stay/statistics & numerical data , Mastectomy , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Transplantation, Autologous , United Kingdom/epidemiology
3.
Plast Surg Nurs ; 41(1): 36-39, 2021.
Article in English | MEDLINE | ID: covidwho-1218019

ABSTRACT

On March 11, 2020, the World Health Organization declared COVID-19 to be a pandemic, challenging health care systems all over the world. National health care systems have reorganized to cope with the disease. Surgical services departments around the world have been affected and elective surgical procedures have been postponed to conserve medical resources. When a patient with COVID-19 requires an urgent microsurgical free flap due to trauma or a tumor, personnel from the health care facility must have a protocol in place to follow for the patient's care and follow-up. In this article, we present our protocol for patients with COVID-19 requiring reconstructive microsurgery.


Subject(s)
COVID-19/prevention & control , Free Tissue Flaps/transplantation , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Microsurgery/methods , Perioperative Care/methods , Reconstructive Surgical Procedures/methods , Aftercare/methods , Aftercare/standards , COVID-19/complications , COVID-19/transmission , Clinical Protocols , Hospitals, University , Humans , Infection Control/standards , Microsurgery/standards , Perioperative Care/standards , Reconstructive Surgical Procedures/standards , Spain
5.
Otol Neurotol ; 42(4): 606-613, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-913295

ABSTRACT

BACKGROUND: During the Covid-19 pandemic, otolaryngologists are at risk due to aerosol-generating procedures such as mastoidectomy and need enhanced personal protective equipment (PPE). Eye protection can interfere with the use of a microscope due to a reduction in the field of vision. We aimed to study the effect of PPE on the microsurgical field. METHODS: Five surgeons measured the visual field using digital calipers at different power settings. They were done with no PPE, a surgical mask, FFP3 mask (N99), and with the addition of small goggles, large vistamax goggles, vistamax plus a face shield, and only a face shield. The measurements were repeated with rings of 5 mm increments. We also measured the "eye relief" of the microscope which is the ideal distance for maximum field of view. RESULTS: There was no major reduction of the field with the surgical or FFP3 mask. But even simple goggles reduced the field up to 31.6% and there were progressive reductions of up to 75.7% with large goggles, 76.8% when a face shield was added, and 61.9% when only face shield was used. The distance rings more than 5 mm also affected the field of view.The eye relief of our eyepiece was found to be 15 mm. CONCLUSION: The current PPE eye protection is not compatible with the use of a microscope. There is scope for research into better eye protection. Mitigation strategies including barrier drapes and alternative techniques such as endoscopic surgery or use of exoscopes should also be considered.


Subject(s)
COVID-19/prevention & control , Microsurgery , Otolaryngologists , Personal Protective Equipment/adverse effects , Visual Fields , COVID-19/transmission , Humans , Mastoidectomy/adverse effects , Microsurgery/instrumentation , Microsurgery/methods , SARS-CoV-2
7.
J Hand Surg Am ; 45(9): 869-875, 2020 09.
Article in English | MEDLINE | ID: covidwho-684289

ABSTRACT

The case spectrum in hand surgery is one of extremes-purely elective day surgery cases under local anesthesia to mangling limb injuries that require immediate, and frequently, lengthy, surgery. Despite the cancellation of most elective orthopedic and plastic surgical procedures, hand surgeons around the world continue to see a steady stream of limb-threatening cases such as severe trauma and infections that require emergent surgical care. With the increase in community-spread, an increasing number of COVID-19-infected patients may be asymptomatic or have mild, nonspecific or atypical symptoms. Some of them may already have an ongoing, severe infection. The time-sensitive nature of some of these cases means that hand surgeons may need to operate urgently on patients who may be suspected of COVID-19 infections, often before confirmatory test results are available. General guidelines for perioperative care of the COVID-19-positive patient have been published. However, our practices differ from those of general orthopedic and plastic surgery, primarily because of the focus on trauma. This article discusses the perioperative and technical considerations that are essential to manage the COVID-19 patient requiring emergency care, without compromising clinical outcomes and while ensuring the safety of the attending staff.


Subject(s)
Amputation, Traumatic/surgery , Betacoronavirus , Coronavirus Infections , Finger Injuries/surgery , Microsurgery/methods , Pandemics , Pneumonia, Viral , Reconstructive Surgical Procedures/methods , Adult , COVID-19 , Emergency Treatment , Humans , Male , SARS-CoV-2
10.
J Hand Surg Am ; 45(6): 536-541, 2020 06.
Article in English | MEDLINE | ID: covidwho-141759

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic is rapidly evolving. Tan Tock Seng Hospital and the National Centre for Infectious Disease see the majority of confirmed and suspected cases in Singapore. This article describes the impact of COVID-19 on the practice of hand and reconstructive microsurgery (HRM) in our institution. It details our department's response as the situation escalated and the impact on the HRM elective and emergency workload, including the use of personal protective equipment on the surgical practice of HRM, as well as the effects of the condition on social and academic life.


Subject(s)
Coronavirus Infections/epidemiology , Disease Transmission, Infectious/prevention & control , Elective Surgical Procedures/statistics & numerical data , Hand/surgery , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Reconstructive Surgical Procedures/methods , Betacoronavirus , COVID-19 , Communicable Disease Control/methods , Coronavirus Infections/prevention & control , Elective Surgical Procedures/methods , Female , Humans , Male , Microsurgery/methods , Microsurgery/statistics & numerical data , Pandemics/prevention & control , Personal Protective Equipment/supply & distribution , Pneumonia, Viral/prevention & control , Practice Patterns, Physicians'/statistics & numerical data , Reconstructive Surgical Procedures/statistics & numerical data , Risk Assessment , SARS-CoV-2 , Singapore , Treatment Outcome
11.
Head Neck ; 42(6): 1168-1172, 2020 06.
Article in English | MEDLINE | ID: covidwho-116896

ABSTRACT

BACKGROUND: The SARS-CoV-2 (COVID-19) pandemic has caused rapid changes in head and neck cancer (HNC) care. "Real-time" methods to monitor practice patterns can optimize provider safety and patient care. METHODS: Head and neck surgeons from 14 institutions in the United States regularly contributed their practice patterns to a shared spreadsheet. Data from 27 March 2020 to 5 April 2020 was analyzed. RESULTS: All institutions had significantly restricted HNC clinic evaluations. Two institutions stopped free-flap surgery with the remaining scheduling surgery by committee review. Factors contributing to reduced clinical volume included lack of personal protective equipment (PPE) (35%) and lack of rapid COVID-19 testing (86%). CONCLUSIONS: The COVID-19 pandemic has caused a reduction in HNC care. Rapid COVID-19 testing and correlation with infectious potential remain paramount to resuming the care of patients with head and neck cancer. Cloud-based platforms to share practice patterns will be essential as the pandemic evolves.


Subject(s)
Coronavirus Infections/epidemiology , Head and Neck Neoplasms/surgery , Microsurgery/methods , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Practice Patterns, Physicians'/organization & administration , Surgical Oncology/organization & administration , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Communicable Disease Control/organization & administration , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Databases, Factual , Female , Head and Neck Neoplasms/pathology , Humans , Male , Medical Oncology/organization & administration , Patient Safety/statistics & numerical data , Pneumonia, Viral/prevention & control , Program Evaluation , Retrospective Studies , Societies, Medical , Surveys and Questionnaires , United States
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