The Effect of COVID-19 Pandemic on Plastic Surgery Practice in a Tertiary Health Care Center in Egypt.

Abstract

The coronavirus disease of 2019 (COVID-19) pandemic resulted in massive challenges facing plastic surgical practice all over the world. These challenges included limited theatre spaces, surgical and anesthetic staff, and resources and efforts to limit contacts by decreasing hospital visits.1 Different policies and measures have been implemented by institutions all over the world,2,3 and learning about this variability helps in better management of future events. In this article, we present our experience in the plastic surgery department of one of the largest tertiary care hospitals in Cairo, Egypt. The policy adopted by the Egyptian health care system involved screening of all patients, with separation of COVID-19 and non–COVID-19 patients and treating them in separate hospitals.4 At our institution, Ain Shams University, screening has been done using full blood count, computed tomography chest scans, and rapid COVID-19 testing. After the initial screening, suspected COVID-19 as well as respiratory symptomatic cases have been offered the COVID-19 polymerase chain reaction test as well. Patients with confirmed COVID-19 cases are then transferred to COVID-19 hospitals. Efforts to decrease patients’ hospital visits have been made to decrease pressure on overwhelmed hospital departments and to decrease contact and transmission of the disease. All elective surgeries have been stopped. Only trauma and urgent tumor patients have been offered surgery. For trauma patients, we set minor procedure rooms in the emergency department so that patients could have definitive management on their first visit. These patients did not have to undergo the COVID-19 screening investigations. We extended the use of wide-awake, local anesthesia, no tourniquet (WALANT) treatment in these rooms to include simple tendon, digital nerve, and fracture injuries. Reusable splints and absorbable sutures have been used. We have avoided buried Kirschner wires. Patients and relatives looking after them have been taught wound care and given physiotherapy instructions and exercises. Maxillofacial procedures are considered high-risk procedures.5 Wearing level 3 personal protective equipment in all cases has been mandatory. Most zygomatomaxillary, nasal, and orbital fractures have been managed conservatively. Even mandibular fractures have been managed with the minimum amount of intervention possible. For burn patients, our burn unit has been used to manage non–COVID-19 burn patients. Burn patients with suspected or confirmed COVID-19 have been transferred to a quarantine hospital regardless of the percentage of the body burned, with recruitment of burn surgery staff to take care of these patients there. For cancer patients, surgeries for slowly progressing tumors, such as small, recent skin basal cell carcinomas, have been postponed. Head and neck cancer surgeries imposed a great challenge to our department due to the high risk of COVID-19 transmission and the need for intensive care unit beds postoperatively. For breast cancer patients, only implant-based reconstruction has been offered. Free flap reconstruction surgeries have been postponed. Education and training have been badly affected, as most of educational and clinical activities stopped. We managed to arrange multiple online educational meetings and webinars to overcome this. During this pandemic, we learned how to efficiently manage our resources and the need to implement changes, such as providing hospitals with facilities for telemedicine and virtual patient consultations. Health care systems should be prepared to face such events. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. No funding was received for this article.