Current impact of Covid-19 pandemic on Spanish plastic surgery departments: a multi-center report.

BACKGROUND: After its initial description in China, Covid-19 is hitting nations across the world, with Spain as the third country in number of deaths, after the USA and Italy. Similarly to what is happening in other countries, an important reduction in available operating rooms is affecting our departments. In this study, we aim to know how Covid-19 pandemic is affecting the delivery of plastic surgery services in Spain. METHODS: A questionnaire addressing some of our concerns about how the Coronavirus crisis might severelyimpact our specialty has been sent to the heads of the divisions of plastic surgery of several hospitals across Spain. RESULTS: A total of 12 plastic surgery departments from different hospitals across the country agreed to participate in the survey. Most plastic surgery teams will need to maintain 50-80% of their staff in order to be able to offer emergency and undelayable oncological procedures. The total amount of procedures currently being performed ranged from 0 to 44% of the figures before the coronavirus outbreak, except for one department, with elective surgery mainly affected. Microsurgical cases have been massively discontinued during this crisis. CONCLUSIONS: Plastic surgery delivery in the Spanish Health System is being severely impacted as a collateral damage from this pandemic. Most of the elective surgery is currently stopped. Our departments seem to be vulnerable regarding their capacity to keep offering emergency care.Level of evidence: not ratable (multi-center survey).

Development of an integrative algorithm for the treatment of various stages of full-thickness burns of the first commissure of the hand.

Burns of the first commissure of the hand can evolve into an adduction contracture of the thumb. We decided to conduct a review of the existing literature on the treatment of full-thickness burns of the first commissure in order to develop a treatment algorithm that integrates the various currently available procedures. A search of the existing literature was conducted, focusing on the treatment of a burn of the first commissure in its chronic and acute phases. A total of 29 relevant articles were selected; 24 focused exclusively on the chronic contracture stage, while 3 focused exclusively on the acute burn stage, and 2 articles studied both stages. A therapeutic algorithm for full-thickness burns of the first commissure of the hand was developed. With this algorithm we sought to relate each degree and stage of the burn with a treatment.

The management of pain associated with wound care in severe burn patients in Spain.

OBJECTIVE: To describe the management of pain prevention associated with burn care. METHODS: Multi-centre, observational, cross-sectional, descriptive study performed in 4 burn units in Spain. RESULTS: A total of 55 patients undergoing 64 procedures were analysed. Burns were classified as severe (90.4%), third-degree (78.2%) and caused by thermal agents (81.8%). Background analgesia consisted of non-opioid drugs (87.5%) and opioids (54.7%) [morphine (20.3%), morphine and fentanyl (14.1%) or fentanyl monotherapy (15.6%)]. Burn care was performed by experienced nurses (96.9%); 36.5% followed guidelines. The mean duration of procedures was 44 minutes (Statistical Deviation, SD: 20.2) and the mean duration of pain was 27 minutes (SD: 44.6). Procedural pain was primarily managed with opioid analgesics: fentanyl monotherapy and in combination (84%) and fentanyl monotherapy (48%) administered sublingually (89.1%). Patients described pain as different to usual baseline pain (97%), with a mean maximum intensity score of 4.2 points (SD: 3.3) on the VAS scale and a 34% increase in the intensity of pain. The mean patient and healthcare professional satisfaction score per procedure was 6/10 (SD: 1.9) and 5.5/10 (SD: 1.7), respectively. CONCLUSION: The results of the study describe the management of pain associated with burn care in clinical practice, helping optimise pain control.

Spanish transcultural adaptation of the Leuven Itch Scale.

Itching is one of the most frequent symptoms, and most resistant to treatment, relating to scar formation after burns. The Leuven Itch Scale is a questionnaire which has been validated for use in burns, analysing different clinical dimensions of pruritus. However, until now there was no Spanish version available for use with Spanish-speaking patients. This article presents the process of the academic translation of the questionnaire in order to obtain a Spanish version, and the final version of the questionnaire. We followed a translation/back-translation methodology with a final pilot test on a sample of burn patients. The final result fills a major gap in the quality-of-life questionnaires available in Spanish.