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1.
Plast Reconstr Surg ; 148(1): 133e-139e, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1284960

ABSTRACT

SUMMARY: The coronavirus disease of 2019 pandemic became a global threat in a matter of weeks, with its future implications yet to be defined. New York City was swiftly declared the epicenter of the pandemic in the United States as case numbers grew exponentially in a matter of days, quickly threatening to overwhelm the capacity of the health care system. This burgeoning crisis led practitioners across specialties to adapt and mobilize rapidly. Plastic surgeons and trainees within the New York University Langone Health system faced uncertainty in terms of future practice, in addition to immediate and long-term effects on undergraduate and graduate medical education. The administration remained vigilant and adaptive, enacting departmental policies prioritizing safety and productivity, with early deployment of faculty for clinical support at the front lines. The authors anticipate that this pandemic will have far-reaching effects on the future of plastic surgery education, trends in the pursuit of elective surgical procedures, and considerable consequences for certain research endeavors. Undoubtedly, there will be substantial impact on the physical and mental well-being of health care practitioners across specialties. Coordinated efforts and clear lines of communication between the Department of Plastic Surgery and its faculty and trainees allowed a concerted effort toward the immediate challenge of tempering the spread of coronavirus disease of 2019 and preserving structure and throughput for education and research. Adaptation and creativity have ultimately allowed for early rebooting of in-person clinical and surgical practice. The authors present their coordinated efforts and lessons gleaned from their experience to inform their community's preparedness as this formidable challenge evolves.


Subject(s)
COVID-19/epidemiology , Communicable Disease Control/standards , Pandemics/prevention & control , Surgery, Plastic/trends , Academic Medical Centers/standards , Academic Medical Centers/statistics & numerical data , Academic Medical Centers/trends , COVID-19/prevention & control , COVID-19/transmission , Education, Medical, Graduate/organization & administration , Education, Medical, Graduate/standards , Education, Medical, Graduate/trends , Elective Surgical Procedures/education , Elective Surgical Procedures/standards , Elective Surgical Procedures/trends , Faculty/organization & administration , Faculty/psychology , Faculty/statistics & numerical data , Forecasting , Humans , Internship and Residency/statistics & numerical data , New York City/epidemiology , Personnel Staffing and Scheduling/organization & administration , Personnel Staffing and Scheduling/trends , Reconstructive Surgical Procedures/education , Reconstructive Surgical Procedures/standards , Reconstructive Surgical Procedures/trends , Surgeons/organization & administration , Surgeons/psychology , Surgeons/statistics & numerical data , Surgery, Plastic/education , Surgery, Plastic/organization & administration , Surgery, Plastic/standards , Surveys and Questionnaires/statistics & numerical data , Uncertainty , Universities/standards , Universities/statistics & numerical data , Universities/trends
2.
Plast Reconstr Surg ; 148(1): 168e-169e, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1263729

Subject(s)
COVID-19/prevention & control , Infection Control/organization & administration , Pandemics/prevention & control , Surgery Department, Hospital/organization & administration , Surgery, Plastic/organization & administration , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/transmission , COVID-19 Testing/standards , COVID-19 Testing/statistics & numerical data , COVID-19 Testing/trends , Egypt/epidemiology , Elective Surgical Procedures/standards , Elective Surgical Procedures/statistics & numerical data , Elective Surgical Procedures/trends , Health Policy , Humans , Infection Control/standards , Infection Control/statistics & numerical data , Infection Control/trends , Reconstructive Surgical Procedures/standards , Reconstructive Surgical Procedures/statistics & numerical data , Reconstructive Surgical Procedures/trends , SARS-CoV-2/isolation & purification , Surgery Department, Hospital/standards , Surgery Department, Hospital/statistics & numerical data , Surgery Department, Hospital/trends , Surgery, Plastic/standards , Surgery, Plastic/statistics & numerical data , Surgery, Plastic/trends , Telemedicine/organization & administration , Telemedicine/standards , Telemedicine/statistics & numerical data , Tertiary Care Centers/organization & administration , Tertiary Care Centers/standards , Tertiary Care Centers/statistics & numerical data , Tertiary Care Centers/trends , Triage/organization & administration , Triage/standards , Triage/statistics & numerical data , Triage/trends
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
4.
Spine (Phila Pa 1976) ; 45(19): 1386-1394, 2020 Oct 01.
Article in English | MEDLINE | ID: covidwho-1109345

ABSTRACT

STUDY DESIGN: Case series. OBJECTIVE: For each of the most frequent clinical scenarios, the authors reached a consensus on how should be timing and indications be optimized to reduce risk while maintaining the expected outcomes under the Covid-19 pandemics. SUMMARY OF BACKGROUND DATA: The organization of health care has been changed by the Covid-19 pandemic with a direct impact on Spine Oncology Surgery. Emergency surgery is still a priority, but in case of spinal tumors it should be better defined which conditions require emergency treatment. METHODS: An expert panel with general spine surgeons, oncological spine surgeons, and radiation oncologists was formed to analyze the most frequent scenarios in spinal musculoskeletal oncology during Covid-19 pandemics. RESULTS: Spine metastases can be found incidentally during follow-up or can clinically occur by increasing pain, pathologic fracture, and/or neurological symptoms. Primary spine tumors are much more rare and very rarely present with acute onset. The first step is to suspect this rare condition, to avoid to treat a primary tumor as it were a metastasis. Most complex surgery, like en bloc resection, associated with high morbidity and mortality rate for the treatment of low grade malignancy like chordoma or chondrosarcomas, if intensive care unit availability is reduced, can be best delayed some weeks, as not impacting on prognosis, due to the slow growth rate of these conditions. The currently accepted protocols for Ewing sarcoma (ES) and osteogenic sarcoma must be performed for local and systemic disease control. For ES, after the first courses of chemotherapy, radiotherapy can be selected instead of surgery, during Covid-19, to the end of the full course of chemotherapy. In immunocompromised patients, (treated by chemotherapy), it is necessary to avoid contact with affected or exposed people. CONCLUSION: Even more than during normal times, a multidisciplinary approach is mandatory to share the decision to modify a treatment strategy. LEVEL OF EVIDENCE: 5.


Subject(s)
Betacoronavirus , Coronavirus Infections/surgery , Medical Oncology/standards , Pandemics , Pneumonia, Viral/surgery , Spinal Neoplasms/surgery , Surgeons/standards , Adult , COVID-19 , Clinical Decision-Making/methods , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/epidemiology , Female , Humans , Male , Medical Oncology/methods , Middle Aged , Pandemics/prevention & control , Patient Care Team/standards , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/epidemiology , Prognosis , Reconstructive Surgical Procedures/methods , Reconstructive Surgical Procedures/standards , SARS-CoV-2 , Spinal Neoplasms/diagnostic imaging , Spinal Neoplasms/epidemiology , Surgeons/psychology
5.
J Plast Reconstr Aesthet Surg ; 74(9): 2133-2140, 2021 09.
Article in English | MEDLINE | ID: covidwho-1014371

ABSTRACT

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic has generated enormous pressure on healthcare establishments, prompting the restructuring of services to rationalise resources. Complex head and neck reconstructive surgery in this setting may carry substantial risk to patients and staff. This paper outlines the management strategy and outcomes of major head and neck oncological cases at a single regional tertiary referral centre. METHODS: A database review was undertaken of consecutive patients undergoing major head and neck surgery and reconstruction during the COVID-19 pandemic at St Andrew's Centre for Plastic Surgery & Burns, Chelmsford UK. Patient demographics, tumour and reconstruction characteristics as well as peri­operative information were determined. Patients were prospectively contacted with regard to COVID-related symptoms and investigations. RESULTS: Twenty-two patients (15 males and 7 females) with a mean age of 67 years (range: 36-92 years) were included between March 1 and June 13, 2020. Patients underwent pre-operative throat swabs at 72 h and 24 h as well as chest CT scanning as part of a robust protocol. Twelve free flaps, four loco-regional flaps, four parotidectomies and 23 cervical lymphadenectomies were performed. Two patients required a return to theatre. No post-operative deaths occurred and flap survival rate was 100%. A single patient tested positive for COVID-19 pre-operatively and no post-operative COVID-19 infections occurred. CONCLUSION: Although head and neck surgery represents a high-risk procedure to patients and healthcare professionals, our institutional experience suggests that in the presence of a robust peri­operative protocol and judicious patient selection, major head and neck surgery, including free tissue transfer reconstruction, may be performed safely.


Subject(s)
COVID-19/diagnosis , COVID-19/prevention & control , Carcinoma, Squamous Cell/surgery , Head and Neck Neoplasms/surgery , Infection Control/methods , Perioperative Care/methods , Reconstructive Surgical Procedures/methods , Adult , Aged , Aged, 80 and over , COVID-19/etiology , COVID-19 Testing/methods , Clinical Protocols , Female , Humans , Infection Control/standards , Male , Middle Aged , Neck Dissection , Patient Selection , Perioperative Care/standards , Postoperative Complications/diagnosis , Postoperative Complications/prevention & control , Reconstructive Surgical Procedures/standards , Surgical Flaps , Tertiary Care Centers , Treatment Outcome , United Kingdom
12.
J Plast Reconstr Aesthet Surg ; 74(1): 203-210, 2021 01.
Article in English | MEDLINE | ID: covidwho-695152

ABSTRACT

INTRODUCTION: The COVID-19 pandemic having spread globally has profound implications on medical and surgical care, which is given by the health care providers. At this time, though there are guidelines and recommendations for medical management of these patients, there is a lack of guidance on how a plastic surgeon should approach the COVID-19 suspect or infected patient who presents either in an elective or emergency setting. We aim to provide a consensus guideline based on the current recommendations of the Indian Council of Medical Research (ICMR) and the pooled experience of the major centers performing plastic and reconstructive surgery in India. METHODS: The current guidelines and recommendations on the COVID-19 pandemic were studied from both government and nongovernment sources including ICMR. The problems in the specialty of plastic surgery were categorized into four groups and for each group, separate and individual guidelines have been formulated. GUIDELINES: Consensus guidelines have been formulated for the specialty of Plastic and Reconstructive surgery. The patients requiring plastic surgery service have been categorized into four groups of acute, subacute, chronic, and late category. Acute cases are the ones who require intervention within 24-48 h. Subacute cases are the ones who require intervention in the next 3-10 days, while the chronic are the ones who need plastic surgery preferably within a month. The late category are the ones who need surgery within the next six months. This has been done based on the urgency and priority of surgical intervention titrated against the risks of operating and inadvertently acquiring the exposure of COVID-19-positive patients. CONCLUSION: Currently, in the wake of COVID-19 pandemic, there are no clear guidelines specific to the vast majority of patients who come for a plastic surgery intervention. This puts the patients at risk due to the impending plastic surgery problem while at the same time it poses a risk of exposure to COVID-19 for the surgical team. Consensus guidelines are presented, to steer the plastic surgeon in his work, in the wake of COVID-19 crisis. The guidelines are based on firm scientific evidence from the reputed research and regulatory bodies and have been made in consonance with plastic surgery experts around the country, so that these practices best suit the needs of the patients, while being mindful of resource limitations and infection risks. The approach of "delayed conservative treatment" works best in the present case scenario.


Subject(s)
COVID-19 , Practice Patterns, Physicians' , Reconstructive Surgical Procedures/standards , Surgery, Plastic , Consensus Development Conferences as Topic , Humans , India , Practice Guidelines as Topic
13.
Plast Reconstr Surg ; 146(2): 437-446, 2020 08.
Article in English | MEDLINE | ID: covidwho-692689

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has confronted the U.S. health care system with unprecedented challenges amidst a tenuous economic environment. As inpatient hospitals across the country prepare for an overwhelming influx of highly contagious COVID-19 cases, many nonemergent procedures have been cancelled or indefinitely postponed without guidance regarding eventual safe accommodation of these procedures in the future. Given the potentially prolonged impact of the COVID-19 pandemic on health care use, it is imperative for plastic surgeons to collaborate with other medical and surgical specialties to develop surge capacity protocols that allow continuation of safe, high-quality, nonemergent procedures. The purpose of this article is to provide necessary and timely public health information relevant to plastic surgery and also share a conceptual framework to guide surge capacity protocols for nonemergent surgery.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Regional Health Planning/organization & administration , Surge Capacity/organization & administration , Surgery, Plastic/organization & administration , Ambulatory Surgical Procedures/standards , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Coronavirus Infections/transmission , Elective Surgical Procedures/standards , Humans , Infection Control/standards , Intersectoral Collaboration , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Pneumonia, Viral/transmission , Practice Guidelines as Topic , Reconstructive Surgical Procedures/standards , Regional Health Planning/standards , SARS-CoV-2 , Surgery, Plastic/standards , Surgicenters/organization & administration , Surgicenters/standards , Telemedicine/organization & administration , Telemedicine/standards , United States
14.
Ann Plast Surg ; 85(2S Suppl 2): S166-S170, 2020 08.
Article in English | MEDLINE | ID: covidwho-601389

ABSTRACT

BACKGROUND: The global COVID-19 pandemic has had a profound impact on facial plastic and reconstructive surgery. Our review serves as a safety resource based on the current literature and is aimed at providing best-practice recommendations. Specifically, this article is focused on considerations in the management of craniomaxillofacial trauma as well as reconstructive procedures after head and neck oncologic resection. METHODS: Relevant clinical data were obtained from peer-reviewed journal articles, task force recommendations, and published guidelines from multiple medical organizations utilizing data sources including PubMed, Google Scholar, MEDLINE, and Google search queries. Relevant publications were utilized to develop practice guidelines and recommendations. CONCLUSIONS: The global COVID-19 pandemic has placed a significant strain on health care resources with resultant impacts on patient care. Surgeons operating in the head and neck are particularly at risk of occupational COVID-19 exposure during diagnostic and therapeutic procedures and must therefore be cognizant of protocols in place to mitigate exposure risk and optimize patient care.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Craniocerebral Trauma/surgery , Face/surgery , Head and Neck Neoplasms/surgery , Pandemics/prevention & control , Perioperative Care/methods , Pneumonia, Viral/prevention & control , Reconstructive Surgical Procedures/methods , COVID-19 , Clinical Protocols , Health Care Rationing , Humans , Infection Control/methods , Perioperative Care/standards , Reconstructive Surgical Procedures/standards , SARS-CoV-2
15.
Plast Reconstr Surg ; 146(3): 681-689, 2020 09.
Article in English | MEDLINE | ID: covidwho-525717

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19), a novel coronavirus originating in December of 2019 in Wuhan, People's Republic of China, has spread rapidly throughout the globe over 3 months. On March 11, 2020, the World Health Organization declared COVID-19 a global pandemic. COVID-19 represents a nearly unprecedented threat to both the public health and the durability of our health care systems and will profoundly affect the field of plastic and reconstructive surgery. The objective of this article is to provide a natural history of COVID-19-including virology, epidemiology, and transmission patterns-and a guide for plastic surgeons regarding patient and resource management. METHODS: The authors reviewed existing literature regarding COVID-19, both primary research and secondary reviews, by means of PubMed queries, and recommendations from relevant professional organizations (e.g., American College of Surgeons and American Society of Plastic Surgeons). The literature and recommendations were summarized to provide a specific guide for plastic surgeons. RESULTS: Internationally, over 5.7 million cases and 357,000 deaths from COVID-19 have been reported at the time of writing. No pharmacologic treatments have been identified, but epidemiologic strategies were identified to prevent viral spread, preserve health care resources, and protect patients and surgeons globally. Specific recommendations for plastic and reconstructive surgeons include postponing elective cases and transitioning to telecommunication platforms for patient consultations and education. CONCLUSIONS: COVID-19 represents a nearly unprecedented threat to the public health and the durability of health care systems in the contemporary era. Although plastic and reconstructive surgery may seem relatively remote from the pandemic in direct patient care and exposure, our field can significantly enhance health care resource management.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Disease Transmission, Infectious/prevention & control , Perioperative Care/standards , Pneumonia, Viral/epidemiology , Reconstructive Surgical Procedures/standards , COVID-19 , Coronavirus Infections/transmission , Humans , Pandemics , Pneumonia, Viral/transmission , SARS-CoV-2
18.
Facial Plast Surg Aesthet Med ; 22(4): 233-237, 2020.
Article in English | MEDLINE | ID: covidwho-260116

ABSTRACT

The impact of the COVID-19 pandemic has resulted in widespread disruption to routine surgical services across the globe. As the peak of the initial pandemic passes, surgeons will increasingly resume elective work to address the backlog. Whilst urgent cases such as cancer work will be prioritized, the safe resumption of facial plastic surgery will remain an ongoing challenge; particularly if there are secondary waves of infection. Rhinoplasty and nasal reconstructive surgery in particular poses a unique challenge to address due to the due to the potential for aerosolizing the virus. A task force of facial plastic surgeons from the European Academy of Facial Plastic Surgery has collaborated to create this document detailing recommendations for resuming a safe facial plastic surgery practice. These include the need to embrace telemedicine, advice on surgical prioritization, planning of clinical area flow plans, advice on pre-/peri- and postoperative care as well as recommendations on training for residents and well-being for surgeons. The recommendations have been made in line with the best available evidence in the literature and are applicable to facial plastic surgery colleagues from around the world in order to resume a safe practice.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Elective Surgical Procedures/standards , Pandemics/prevention & control , Perioperative Care/standards , Pneumonia, Viral/prevention & control , Reconstructive Surgical Procedures/standards , COVID-19 , Coronavirus Infections/transmission , Elective Surgical Procedures/methods , Europe , Humans , Perioperative Care/methods , Pneumonia, Viral/transmission , Reconstructive Surgical Procedures/methods , SARS-CoV-2
19.
Ann Plast Surg ; 85(2S Suppl 2): S155-S160, 2020 08.
Article in English | MEDLINE | ID: covidwho-155088

ABSTRACT

BACKGROUND: A novel coronavirus disease (COVID-19) was first reported in December 2019 in China and was soon declared a pandemic by the World Health Organization. Many elective and nonessential surgeries were postponed worldwide in an effort to minimize spread of disease, as well as to conserve resources. Our goal with this article is to review current practice guidelines in setting of the COVID-19 pandemic, based on available data and literature. METHODS: Websites pertaining to surgical and medical societies, and government agencies were reviewed, along with recently published literature to identify recommendations related to COVID-19 and plastic surgery procedures. RESULTS: Clinical practice modifications are recommended during the pandemic in outpatient and perioperative settings. Use of personal protective equipment is critical for aerosol-generating procedures, such as surgery in the head and neck area. Care for trauma and malignancy should continue during the pandemic; however, definitive reconstruction could be delayed for select cases. Specific recommendations were made for surgical treatment of cancer, trauma, and semiurgent reconstructive procedures based on available data and literature. CONCLUSIONS: The risk and benefit of each reconstructive procedure should be carefully analyzed in relation to necessary patient care, minimized COVID-19 spread, protection of health care personnel, and utilization of resources. Recommendations in this article should be taken in the context of each institute's resources and prevalance of COVID-19 in the region. It should be emphasized that the guidelines provided are a snapshot of current practices and are subject to change as the pandemic continues to evolve.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Infection Control/standards , Pandemics/prevention & control , Perioperative Care/standards , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , Reconstructive Surgical Procedures/standards , COVID-19 , Coronavirus Infections/transmission , Elective Surgical Procedures/methods , Elective Surgical Procedures/standards , Global Health , Health Care Rationing/methods , Health Care Rationing/standards , Health Services Accessibility/standards , Humans , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Perioperative Care/methods , Pneumonia, Viral/transmission , Reconstructive Surgical Procedures/methods , Risk Assessment , SARS-CoV-2
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