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Surgical Lip Cancer Reconstruction in the COVID-19 Era: Are Free Flaps or Loco-Regional Flaps Better? SURGERIES 2023. [DOI: 10.3390/surgeries4010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Lip carcinoma is one of the most frequent conditions affecting the general population. It is among the ten most common neoplasms, but despite advances in research and therapy, its prognosis has not improved in a significant way in the past few years, making it a challenge in the medical research field and in surgical treatment. This study was conducted with the aim of evaluating the available reconstructive surgical options for the treatment of lip carcinomas in order to define which could be the most appropriate technique to achieve satisfying aesthetic and functional outcomes considering hospital resources in the COVID-19 era. Seventeen patients were included in this retrospective study, which took place between January 2019 and April 2021. There were two groups: seven patients who underwent a radial forearm free flap and ten who underwent locoregional flaps. The statistical analysis was performed to evaluate four different endpoints. Surgical length, ICU stay, and hospitalization time were minor for locoregional flaps. There was no statistically significant difference between the two groups when considering post-operative complications. Locoregional flaps have a more aesthetically pleasing result, but from a functional point of view, the results can be superimposable. Both techniques are associated with adequate speech, mouth opening, sealing, and symmetry. Given the impact of the COVID-19 pandemic on the healthcare system, locoregional flaps have been proven to be a good surgical option in the reconstruction of lip defects both in terms of aesthetics and functional outcome.
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McCann A, Singerman K, Coxe J, Singletary J, Wang J, Collar R, Hsieh TY. Quantifying Aerosol Generation in Maxillofacial Trauma Repair Techniques. Craniomaxillofac Trauma Reconstr 2022; 15:362-368. [PMID: 36387309 PMCID: PMC9647378 DOI: 10.1177/19433875211059314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023] Open
Abstract
Study Design Cadaveric simulation study. Objective The novel coronavirus (COVID-19), which can be transmitted via aerosolized viral particles, has directed focus on protection of healthcare workers during procedures involving the upper aerodigestive tract, including maxillofacial trauma repair. This study evaluates particle generation at different distances from open reduction and internal fixation (ORIF) of maxillofacial injuries in the intraoperative setting to reduce the risk of contracting airborne diseases such as COVID-19. Methods Two cadaveric specimens in a simulated operating room underwent ORIF of midface and mandible fractures via intraoral incisions as well as maxillomandibular fixation (MMF) using hybrid arch bars. ORIF was performed with both self-drilling screws and with the use of a power drill for creating guide holes. Real-time aerosol concentration was measured throughout each procedure using 3 particle counters placed 0.45, 1.68, and 3.81 m (1.5, 5.5, and 12.5 feet, respectively) from the operative site. Results There was a significant decrease in particle concentration in all procedures at 1.68 m compared to 0.45 m, but only 2 of the 5 procedures showed further significant decrease in particle concentration when going from 1.68 to 3.81 m from the operative site. There was significantly less particle concentration generated at all distances when using self-drilling techniques compared to power drilling for ORIF. Conclusions Consideration of using self-drilling screwing techniques as well as maintaining physical distancing protocols may decrease risk of transmission of airborne diseases such as COVID-19 while in the intraoperative setting.
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Affiliation(s)
- Adam McCann
- Department of Otolaryngology - Head and
Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Kyle Singerman
- Department of Otolaryngology - Head and
Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - James Coxe
- Department of Otolaryngology - Head and
Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - John Singletary
- Department of Environmental and Public
Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Jun Wang
- Department of Environmental and Public
Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Ryan Collar
- Department of Otolaryngology - Head and
Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Tsung-yen Hsieh
- Department of Otolaryngology - Head and
Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
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Pandemics and facial plastics and reconstructive surgery. OPERATIVE TECHNIQUES IN OTOLARYNGOLOGY-HEAD AND NECK SURGERY 2022; 33:128-133. [PMID: 35502267 PMCID: PMC9045863 DOI: 10.1016/j.otot.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this article is to review the impact of COVID-19 on the specialty of Facial Plastic and Reconstructive Surgery. Initially, COVID-19 caused significant disruption to facial plastic surgeon practices and patient care with cancellation of surgery and clinical practice. As medical practices resumed, facial plastic surgeons were resilient and adaptive. Reliance on technology helped to meet the needs of patients. There was a surge of facial plastic surgery interest and procedures as the pandemic wore on with recovery of many physician practices. COVID-19 created numerous challenges for facial plastic and reconstructive surgeons but also many opportunities. The facial plastic surgery community and the American Academy of Facial Plastic and Reconstructive Surgery worked together to achieve best outcomes.
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Dhanani R, Wasif M, Pasha HA, Ghaloo SK, Hussain M, Shah Vardag AB. Ethical Dilemmas in the Management of Head and Neck Cancers in the Era of the COVID-19 Pandemic. Turk Arch Otorhinolaryngol 2022; 60:42-46. [PMID: 35634234 PMCID: PMC9103564 DOI: 10.4274/tao.2022.2021-11-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/26/2022] [Indexed: 12/01/2022] Open
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Bhaskaran D, Chandran A, T.M SR. Plastic Surgery Practice during COVID Times. Indian J Plast Surg 2022; 55:54-57. [PMID: 35444754 PMCID: PMC9015828 DOI: 10.1055/s-0041-1740079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction
COVID-19 has affected plastic surgeons like never before. We conducted an all-India survey to find how the practice was affected among public/private sector, reconstructive/aesthetic practice, and consultants/residents. We have proposed some solutions to the identified problems, which are supported by previous literature.
Methods
A survey framed in Google forms was circulated through WhatsApp and emails in August 2020. Closed and semiopen questions regarding changes in personal and professional lives, coping strategies adopted, and open questions for suggestions in improving practice, academics and measures to tackle the pandemic were included. Responses were collected in an Excel sheet and analysis done using SPSS software.
Results
A total of 220 consented responses were obtained. Public hospital practitioners had to bear the COVID-related administrative as well as executive works, especially residents, which led to anxiety, family concern, burnout, and concern about the loss of skills and academics. Patient interaction was also reduced. Aesthetic surgeons bore more financial loss.
Conclusions
Plastic surgeons in India faced decrease in caseload, financial loss, COVID-related duties, workload for residents, reduced academics, family and mental health problems, difficulty with personal protection equipment (PPE) during surgeries, and queries from patients. These can be solved by doing cases within the limits of protocols and safety, pooling public and private sector for COVID duties, rotating residents' groups to reduce workload, using telemedicine for academics and patient consultations, and providing social support groups to surgeons.
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Affiliation(s)
- Deepak Bhaskaran
- Department of Plastic and Reconstructive Surgery, Government Medical College, Kozhikode, Kerala, India
| | - Aswathy Chandran
- Department of Plastic and Reconstructive Surgery, Government Medical College, Kozhikode, Kerala, India
| | - Sheeja Rajan T.M
- Department of Plastic and Reconstructive Surgery, Government Medical College, Kozhikode, Kerala, India
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Mukarramah DA, Rini IS, Sofyan RF, Kiat MI, Iskandar I, Ritana A, Brahma B. Oncologic Head and Neck Reconstructive Microsurgery during the COVID-19 Pandemic in Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia. JOURNAL OF RECONSTRUCTIVE MICROSURGERY OPEN 2021. [DOI: 10.1055/s-0041-1736420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Abstract
Background Head and neck cancer is one of the leading cancers worldwide. Complex head and neck procedures are potentially aerosol-generating and considered high risk for coronavirus disease 2019 (COVID-19) transmission between the patients, surgeons, and other health-care workers (HCWs). Several adjustments in the microsurgery procedure were needed. The COVID-19 protocol was developed and applied to minimize the COVID-19 transmission. The study objectives were to describe the preoperative, intraoperative, and postoperative protocols applied and the characteristics of patients who underwent head and neck reconstructive microsurgery during the COVID-19 pandemic in Dharmais Cancer Hospital-National Cancer Center.
Methods This study was a retrospective descriptive study of patients who underwent head and neck reconstructive microsurgery between March 2020 and December 2020 in the plastic surgery department and surgical oncology department, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia. The patients' characteristics including sex, age, location of the defects, the flap type, flap survival, and complications were obtained from medical records and analyzed using SPSS version 23.
Results There were 55 patients, 30 (54.54%) patients were female, and 25 (45.45%) patients were male. The mean age at the time of surgery was 51.32 ± 1.85 years. The most common cancer type was squamous cell carcinoma for 49.09% (n = 27/55). The most frequent location was tongue for 25.45% (n = 14/55). Anterolateral thigh flap was also the most used flap in this study for 50.91% (n = 14/55). The overall survival rate of this study was 83.64% (n = 46/55). There were nine patients (16.36%) who were found with postoperative complications. There was no nosocomial infection with COVID-19 for patients, surgeons, and other HCWs.
Conclusion Microsurgery can be performed even in the COVID-19 pandemic as the gold standard for oncologic head and neck reconstruction by applying protocols to protect the patients, surgeons, and other HCWs.
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Affiliation(s)
- Dewi Aisiyah Mukarramah
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia
| | - Irena Sakura Rini
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia
| | - Rian Fabian Sofyan
- Department of Surgical Oncology, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia
| | - Muhammad Irsyad Kiat
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia
| | - Iskandar Iskandar
- Department of Surgical Oncology, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia
| | - Azmi Ritana
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia
| | - Bayu Brahma
- Department of Surgical Oncology, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia
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Kovoor JG, Tivey DR, Ovenden CD, Babidge WJ, Maddern GJ. Evidence, not eminence, for surgical management during COVID-19: a multifaceted systematic review and a model for rapid clinical change. BJS Open 2021; 5:6342605. [PMID: 34355242 PMCID: PMC8342932 DOI: 10.1093/bjsopen/zrab048] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus (COVID-19) forced surgical evolution worldwide. The extent to which national evidence-based recommendations, produced by the current authors early in 2020, remain valid, is unclear. To inform global surgical management and a model for rapid clinical change, this study aimed to characterize surgical evolution following COVID-19 through a multifaceted systematic review. METHODS Rapid reviews were conducted targeting intraoperative safety, personal protective equipment and triage, alongside a conventional systematic review identifying evidence-based guidance for surgical management. Targeted searches of PubMed and Embase from 31 December 2019 were repeated weekly until 7 August 2020, and systematic searches repeated monthly until 30 June 2020. Literature was stratified using Evans' hierarchy of evidence. Narrative data were analysed for consistency with earlier recommendations. The systematic review rated quality using the AGREE II and AMSTAR tools, was registered with PROSPERO, CRD42020205845. Meta-analysis was not conducted. RESULTS From 174 targeted searches and six systematic searches, 1256 studies were identified for the rapid reviews and 21 for the conventional systematic review. Of studies within the rapid reviews, 903 (71.9 per cent) had lower-quality design, with 402 (32.0 per cent) being opinion-based. Quality of studies in the systematic review ranged from low to moderate. Consistency with recommendations made previously by the present authors was observed despite 1017 relevant subsequent publications. CONCLUSION The evidence-based recommendations produced early in 2020 remained valid despite many subsequent publications. Weaker studies predominated and few guidelines were evidence-based. Extracted clinical solutions were globally implementable. An evidence-based model for rapid clinical change is provided that may benefit surgical management during this pandemic and future times of urgency.
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Affiliation(s)
- J G Kovoor
- University of Adelaide, Adelaide, South Australia, Australia.,Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - D R Tivey
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - C D Ovenden
- University of Adelaide, Adelaide, South Australia, Australia
| | - W J Babidge
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - G J Maddern
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
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de Boutray M, Kün-Darbois JD, Sigaux N, Lutz JC, Veyssiere A, Sesque A, Savoldelli C, Dakpe S, Bertin H, Lallemant B, Llobet A, du Cailar M, Lauwers F, Davrou J, Foletti JM. Impact of the COVID-19 lockdown on the epidemiology of maxillofacial trauma activity: a French multicentre comparative study. Int J Oral Maxillofac Surg 2020; 50:750-755. [PMID: 33172710 PMCID: PMC7648505 DOI: 10.1016/j.ijom.2020.10.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/20/2020] [Accepted: 10/13/2020] [Indexed: 11/25/2022]
Abstract
The coronavirus disease 2019 (COVID-19) outbreak has had a major impact on medical and surgical activities. A decline in facial trauma incidence was noticed during the lockdown period. The aim of this study was to evaluate the decline in maxillofacial trauma in France during this particular period. A retrospective multicentre comparative study was initiated in 13 major French public hospital centres. The incidence of facial trauma requiring surgery during the first month of lockdown was compared to that during equivalent periods in 2018 and 2019. Differences in the types of trauma were also analysed. Thirteen maxillofacial departments participated in the study. A significant decline in maxillofacial trauma volumes was observed when compared to equivalent periods in 2018 and 2019 (106 patients compared to 318 and 296 patients, respectively), with an average reduction of 65.5% (P = 0.00087). The proportion of trauma due to sports and leisure was reduced when compared to reports in the literature. As a consequence, in the context of a pandemic, the material and human resources related to this activity could be reallocated to the management of other pathologies that cannot be postponed.
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Affiliation(s)
- M de Boutray
- Department of Maxillofacial Surgery, Gui de Chauliac University Hospital Centre, Montpellier University, Montpellier, France.
| | - J-D Kün-Darbois
- Department of Maxillofacial and Oral Surgery, Angers University Hospital, Angers, France.
| | - N Sigaux
- Department of Maxillofacial and Facial Plastic Surgery, Lyon Sud Hospital Centre, Hospices Civils de Lyon, Pierre-Benite, France.
| | - J-C Lutz
- Department of Maxillofacial Surgery and Stomatology, Strasbourg University Hospital Centre, Strasbourg, France.
| | - A Veyssiere
- Department of Maxillofacial and Plastic Surgery, Caen University Hospital, Caen, France.
| | - A Sesque
- Oral and Maxillofacial Surgery Department, Estaing University Hospital, Clermont Ferrand, France.
| | - C Savoldelli
- Head and Neck University Institute, Nice University Hospital, Nice, France.
| | - S Dakpe
- Department of Maxillofacial Surgery, Amiens University Hospital Centre, Amiens, France; UR CHIMERE 7516, Picardie Jules Verne University, Amiens, France.
| | - H Bertin
- Department of Oral and Maxillofacial Surgery, Nantes University Hospital, Nantes, France.
| | - B Lallemant
- Department of Head and Neck Surgery, University Hospital Centre of Nîmes, Nîmes, France.
| | - A Llobet
- Department of Maxillofacial and Oral Surgery, Perpignan Hospital Centre, Perpignan, France.
| | - M du Cailar
- Maxillofacial Surgery Unit, Purpan University Hospital, Toulouse, France.
| | - F Lauwers
- Maxillofacial Surgery Unit, Purpan University Hospital, Toulouse, France.
| | - J Davrou
- Department of Maxillofacial Surgery and Stomatology, La Pitié-Salpêtrière University Hospital, AP-HP, Paris, France.
| | - J-M Foletti
- Aix Marseille University, APHM, IFSTTAR, LBA, La Conception University Hospital, Department of Maxillofacial Surgery, Marseille, France.
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