Turkish Journal of Plastic Surgery

LETTER TO THE EDITOR
Year
: 2021  |  Volume : 29  |  Issue : 3  |  Page : 195--197

COVID-19 pandemic and disciplinary approach in plastic, reconstructive, and esthetic surgery


Zeynep Altuntas, Majid Ismayilzade 
 Department of Plastic and Reconstructive and Aesthetic Surgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey

Correspondence Address:
Dr. Majid Ismayilzade
Department of Plastic and Reconstructive and Aesthetic Surgery, Meram Faculty of Medicine, Necmettin Erbakan University, Meram-42080, Konya
Turkey




How to cite this article:
Altuntas Z, Ismayilzade M. COVID-19 pandemic and disciplinary approach in plastic, reconstructive, and esthetic surgery.Turk J Plast Surg 2021;29:195-197


How to cite this URL:
Altuntas Z, Ismayilzade M. COVID-19 pandemic and disciplinary approach in plastic, reconstructive, and esthetic surgery. Turk J Plast Surg [serial online] 2021 [cited 2022 Jan 18 ];29:195-197
Available from: http://www.turkjplastsurg.org/text.asp?2021/29/3/195/322676


Full Text



Dear Sir,

Coronavirus disease 2019 (COVID-19) outbreak was first identified in December 2019 in China, and the World Health Organization declared the COVID-19 a pandemic on March 11, 2020.[1] On the same date, the disease was confirmed to have reached our country. Besides the departments concerning the infected population directly, there are numerous units, such as plastic, reconstructive, and esthetic surgery, that have significantly important roles both on taking precautions in pandemic period and contributing to normalization process as well. Furthermore, all elective operations have been stopped in many countries to minimalize the mortality rate of virus.[2] Declaring about the unurgent conditions and unnecessary applications to hospitals on March 17, 2020, The Turkish Society of Plastic, Reconstructive, and Aesthetic Surgeons was one of the leading organizations struggling against COVID-19 pandemic.[3]

The normalization procedure has been initiated in Turkey since June 1, 2020, according to The COVID-19 Pandemic Management and Working Guidelines declared by the Ministry of Health.[4]

The aim of the study is to evaluate the diagnostic data of the patients operated in our clinics and applied to plastic, reconstructive, and esthetic surgery polyclinics during the pandemic period and to lay emphasis on a disciplinary approach in the normalization period.

The patients operated in the department of plastic, reconstructive, and esthetics surgery and the patients applied to the plastic surgery and hand surgery polyclinics between March 15 and June 1, 2020, were included in the study. Diagnostic data of the patients applied to our polyclinics and the surgical indications of the operated patients were analyzed and compared. Considering the surgical area, primarily, the operative procedures with high risk of COVID-19 infection in plastic, reconstructive, and esthetics surgery were determined, and our disciplinary approach was arranged.

Between March 15 and June 1, 2020, a total of 1203 patients applied to the plastic surgery and hand surgery polyclinics and 246 patients underwent several operations in our clinics. 243 patients with hand and upper extremity problems were evaluated in hand surgery polyclinics, while the remaining 960 patients applied to plastic surgery polyclinics. Evaluating diagnostic data, a great majority of patients (n = 579; 48.8%) had a complaints of local skin and/or subcutaneous tissue infection or inflammation. The second most common diagnosis was determined as a pain in various parts of a body with/without soft tissue lesions which was observed in 273 of the patients (22.7%). These diagnoses were followed by the data such as 133 patients (11%) with several wounds of wrist, hand, and fingers; 50 patients (4.15%) with breathing problems due to deviated nasal septum, complaint of shape, and appearance of nose or nasal fracture; 46 patients (3.82%) with soft tissue masses and mass-like conditions; 42 patients (3.49%) with burn injuries in different parts of body; 25 patients (2.07%) with cutaneous malignancies; 24 patients with fractures of skull and facial bones (1.99%); 19 patients (1.57%) with breast disorders; and 12 patients (0.99%) with cleft lip and palate disorders [Table 1].{Table 1}

In our department, 113 of 246 patients (45.9%) were the individuals referred to us from the emergency department and underwent operations due to hand and upper extremity injuries. Second, there were 66 patients (26.6%) with open wounds in various parts of their body caused by different accidents (traffic accidents, industrial accidents, etc.) and reconstructive procedures were executed. 24 patients (9.75%) with maxillofacial injuries and 21 patients (8.53%) with malignancies were operated, while urgent procedures for diabetic wounds were performed in 17 patients (6.9%). Moreover, 5 patients (2.03%) underwent cleft lip and/or cleft palate operative procedures [Table 2].{Table 2}

No esthetical procedure was performed in this period although there were 50 patients with septal deviation and/or esthetical concerns of the nose and 19 patients with breast disorders. The only cases with late cleft lip and/or cleft palate problems and severe deformities that should not be postponed underwent surgical procedures. Cancer surgery was performed to the patients who had diagnosis of malignancy or suspicious lesions.

According to the data, it was demonstrated that nearly half of the patients applied to our polyclinics had complaint of local skin and/or subcutaneous tissue infection or inflammation. A marked difference between the diagnoses can be explained with the change-over in labor policy of the medical departments, especially department of infectious diseases and clinical microbiology. In the pandemic period, cases with a requirement of microsurgical intervention, maxillofacial traumas, severe infections, and malignancies that have metastasis risks were considered as emergent/urgent cases.[5] In our brief investigation, we also found that 203 patients of 246 were the urgent cases directed from emergency department due to maxillofacial injuries, hand and upper extremity injuries, and open wounds following several accidents.

Precautions should also be taken strictly in plastic, reconstructive, and esthetic surgery during the COVID-19 pandemic and normalization terms, respectively. Considering COVID-19 infection, high-level measures are required in some of operations of plastic surgery such as rhinoplasty, maxillofacial trauma surgery, cleft lip/palate surgery, orthognathic surgery, oral neoplasms, and the processes involving oral and nasal spaces. A medical history of patients has to be queried carefully and consecutive tests should be executed if necessary; especially a history of trip abroad and fever accompanying catarrh in the last 3 months is significantly important. Even if no positive sign was detected in examination, the aforementioned high-risk operations should be definitely carried out via personal protective equipment such as eyeglasses, face shields, and masks offering high level of protection.[6] Furthermore, considering aerosol transmission of virus reduction, maneuvers for nasal fractures and surgical repairs of face lacerations concerning oronasal cavities are not recommended under emergency conditions [Table 3].{Table 3}

In addition, treatment of patients from abroad is one of the important issues that should be taken into consideration. In this context, incoming arrangements for medical tourism can be supportive.

To sum up, in plastic surgery, alteration of spectrum of patients and variety of the surgical procedures can be obviously perceived in the COVID-19 pandemic period. Moreover, it can be clearly remarked that similar timetables of these parameters are going to keep on until the end of pandemic. Therefore, in normalization period, it is excessively essential to take strict precautions in plastic, reconstructive, and esthetic surgery like the other areas of health for preventing from re-increase of COVID-19.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1World Health Organization. WHO Characterizes COVID-19 as a Pandemic; 2020. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen. [Last accessed on 29 Mar 20].
2Giunta RE, Frank K, Costa H, Demirdöver C, Di Benedetto G, Elander A, et al. The COVID-19 pandemic and its impact on plastic surgery in Europe – An ESPRAS survey. Handchir Mikrochir Plast Chir 2020;52:221-32.
3Do not occupy hospitals for non- urgent examination and surgical procedures. Turkish Society of Plastic, Reconstructive and Aesthetic Surgery. Available from: http://www.plastikcerrahi.org tr/87/halk-sayfasi-haberler-duyurular/878/lutfen-aciliyeti-olmayanmuayene-ameliyat-ve-islemler-icin-hastaneleri-mesgul-e. [Last accessed on 17 Mar 20].
4Turkish Ministry of Health. Guidance for Management of COVID-19 Pandemic Scientific Advisory Committee Report; 2020. Available from: https://covid19.saglik.gov.tr/TR-66393/covid-19-salgin-yonetimi-ve-calisma-rehberi.html. [Last accessed on 04 Nov 20].
5Demirdover C. The impact of COVID-19 pandemic on plastic reconstructive and aesthetic surgery practice. Turk J Plast Surg 2020;28:133-4.
6Turkish Ministry of Health. Guide for Health Care Institutions Responding to the COVID-19 Pandemic and Infection Control Guidance Scientific Advisory Committee Report; 2020. Available from: https://covid19.saglik.gov.tr/TR-66532/saglik-kurumlarinda-calisma-rehberi-ve-enfeksiyon-kontrol-onlemleri.html. [Last accessed on 14 Dec 20].