Abstract
BackgroundMost of the head and neck cancers are time-critical and need urgent surgical treatment. Our unit is one of the departments in the region, at the forefront in treating head and neck cancers in Pakistan. We have continued treating these patients in the COVID-19 pandemic with certain modified protocols. The objective of this study is to share our experience and approach towards head and neck reconstruction during the COVID-19 pandemic.ResultsThere were a total of 31 patients, 20 (64.5%) were males and 11 (35.4%) patients were females. The mean age of patients was 52 years. Patients presented with different pathologies, i.e. Squamous cell carcinoma n = 26 (83.8%), mucoepidermoid carcinoma n = 2 (6.4%), adenoid cystic carcinoma n = 2 (6.4%) and mucormycosis n = 1 (3%). The reconstruction was done with loco-regional flaps like temporalis muscle flap n = 12 (38.7%), Pectoralis major myocutaneous flap n = 8 (25.8%), supraclavicular artery flap n = 10 (32.2%) and combination of fore-head, temporalis major and cheek rotation flaps n = 1 (3%). Defects involved different regions like maxilla n = 11 (35.4%), buccal mucosa n = 6 (19.3%), tongue with floor of mouth n = 6 (19.3%), mandible n = 4 (12.9%), parotid gland, mastoid n = 3 (9.6%) and combination of defects n = 1 (3%). Metal reconstruction plate was used in 3 (9.6%) patients with mandibular defects. All flaps survived, with the maximum follow-up of 8 months and minimum follow-up of 6 months.ConclusionPedicled flaps are proving as the workhorse for head and neck reconstruction in unique global health crisis. Vigilant use of proper PPE and adherence to the ethical principles proves to be the only shield that will benefit patients, HCW and health system.
Highlights
Corona virus (COVID-19) was first reported in December 2019 in the city of Wuhan, China, and soon it was declared as a global pandemic by the World Health Organization in March 2020 [1]
At the end of March 2020, the COVID-19 outbreak was announced in Pakistan, all the elective procedures were discouraged to conserve the resources and strategically contain the
All patients were pre-operatively screened with PCR COVID-19 nasal swabs and high-resolution CT scan (HRCT) Chest
Summary
Corona virus (COVID-19) was first reported in December 2019 in the city of Wuhan, China, and soon it was declared as a global pandemic by the World Health Organization in March 2020 [1]. All the other urgent and emergency surgical procedures are modified to overcome the burden on the health system. The majority of patients presented to us with advanced cancers, being referred from peripheral hospitals. Such patients could not be further delayed because holding-up treatment would have deleterious. Most of the head and neck cancers are time-critical and need urgent surgical treatment. Our unit is one of the departments in the region, at the forefront in treating head and neck cancers in Pakistan. We have continued treating these patients in the COVID-19 pandemic with certain modified protocols. The objective of this study is to share our experience and approach towards head and neck reconstruction during the COVID-19 pandemic
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