Socioeconomic impact of the COVID-19 pandemic among plastic surgeons in Brazil

Introduction: Global sanitary crisis caused by the spread of COVID-19 induced many health services to stop performing non-urgent surgical procedures. In the scenario of plastic surgery, where most procedures are elective, socioeconomic consequences are estimated for these specialists. The objective of this study is to measure this impact. Methods: Effects of the pandemic within the clinical practice of Brazilian plastic surgeons were investigated through an online questionnaire addressed to members of the Sociedade Brasileira de Cirurgia Plástica. Results: A survey was applied to 645 surgeons. Most respondents reported operation restrictions on procedures and income reduction, especially in regions severely affected by the pandemic. Plastic surgeons with more than 10 years of experience were the most affected. High contamination rates, mental overload, decreased physical activity, and psychiatric medications have also been reported. Conclusion: COVID-19 pandemic brought changes to the personal and professional life of the Brazilian plastic surgeon. Due to the significant reduction in the workload, there were financial impacts on specialists from all country regions, besides physical and mental health issues. Adaptations were mandatory to maintain services and explore new areas of activity to supply the low demand for cosmetic surgery during the crisis

Assessment of the impact on the care of patients with detaching wounds during the COVID-19 pandemic in a specialized service

Introduction: The COVID-19 pandemic was responsible for increasing social isolation rates, resulting in a reduction in traffic accidents. Trauma, in general, is among the most important public health problems worldwide. This study aims to evaluate the impact of social isolation in the city of São Paulo during the COVID-19 pandemic on the care of patients with detaching wounds. Methods: Observational, retrospective and descriptive study. All medical records of patients treated at the Emergency Room of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (HCFMUSP), by the Complex Wounds Group of the Plastic Surgery Service, admitted for detaching wounds and undergoing surgical procedures, were reviewed, from April to June of the years 2019 and 2020. Results: Twenty patients with detaching injuries on the lower limbs were included. In 2019, 14 patients were seen, with a mean age of 47 years, 7 of which were victims of traffic accidents, 5 of being run over, 1 of crushing and 1 of falling from standing height. In 2020, 6 patients were treated with detaching wounds during the pandemic, with a mean age of 36.16 years, 5 of which were victims of motorcycle accidents and 1 of being run over. No patient had COVID-19. Conclusion: During social isolation, there was a numerical reduction in care for detaching trauma during the quarantine period

Reverse sural flap as an alternative to microsurgical reconstruction of extensive foot wound after electrical burn: case report

Introduction: To present a reverse sural flap case report as an alternative to microsurgical flap in foot reconstruction after electrical trauma. The report presented is of a patient treated by the Burns and Complex Wounds groups of the Plastic Surgery Service of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo in 2020. Case Report: Male patient, 35 years old, without comorbidities, victim of high voltage electrical trauma (1300V) at home, affecting upper and lower limbs bilaterally. Due to the severity of the injuries, he underwent left transtibial amputation and serial debridement in the contralateral limb, resulting in a defect in the medial face, hallux and entire dorsum of the right foot, with bone exposure. Due to the failure of reconstruction with a microsurgical flap of the vastus lateralis muscle, reconstruction with a reverse sural flap was chosen. It evolved with distal necrosis, requiring new debridement and re-advancement of the flap. In the follow-up, he presented a favorable evolution and is in the process of rehabilitation. Conclusion: The reverse sural flap proved to be suitable for the salvage treatment of extensive foot injuries after the failure of microsurgical therapy, offering stable coverage and excellent contour, thus allowing satisfactory patient rehabilitation

Versatility and reliability of the Keystone flap in oncological reconstructions

Introduction: The Keystone flap is an island flap with reliable vascularization and simple dissection, first described in 2003. Despite its distinct advantages, there are few scientific publications on this matter, and it is not a common option in the clinical practice of reconstructive surgery. This article aims to report the experience of a cancer referral center with Keystone flaps in oncological reconstructions. Methods: A retrospective study was carried out data from medical records of patients who performed oncological plastic reconstruction with keystone flaps, operated by the Surgery team of the Cancer Institute of the State of São Paulo, in addition to the analysis of pre, intra and postoperative photographic records. Results: Nine patients were identified, all with comorbidities and a mean age of 52.7. Skin defects followed after oncological resections: five in the lower extremities, three in the trunk and one in the face. The mean of the skin resected area was 52.6cm2. The reconstructions were performed under shortened surgical time. There were no postoperative complications or flap losses. The average hospital stay was 2.2 days. Conclusion: The Keystone flap is technically simple and a reproducible option for covering wounds of different sizes and locations. Due to its reliability, simple and quick dissection, shortened hospital stay and low morbidity in the donor area, it should be considered for reconstructing cancer wounds from different locations in patients of all ages

A versatilidade e confiabilidade do retalho Keystone em reconstruções oncológicas

Introdução: O retalho Keystone é um retalho em ilha, de vascularização confiável e dissecção simples, descrito pela primeira vez em 2003. Apesar de suas vantagens, é ainda pouco citado na literatura especializada e longe de se tornar opção de escolha na prática clínica da cirurgia reconstrutiva. O objetivo deste artigo é apresentar a experiência de um serviço oncológico de alta complexidade no uso de retalhos Keystone em reconstruções. Métodos: Um estudo retrospectivo foi desenvolvido por meio do levantamento de dados de prontuário de pacientes operados pela equipe de Cirurgia Plástica do Instituto do Câncer do Estado de São Paulo, além de análise de registros fotográficos pré, intra e pós-operatórios. Resultados: Nove pacientes foram identificados, todos portadores de comorbidades e média de idade de 52,7 anos. Os defeitos cutâneos se seguiram após ressecções oncológicas, sendo cinco em extremidades inferiores, três em tronco e um em face. A média da área ressecada foi de 52,6cm2. As reconstruções foram realizadas sob abreviado tempo cirúrgico. Não houve complicações pós- operatórias ou perdas do retalho e o tempo de hospitalização médio foi de 2,2 dias. Conclusão: O retalho Keystone é uma opção tecnicamente simples e reprodutível para a cobertura de ferimentos de tamanhos diversos e em localizações variadas. Devido à sua confiabilidade, dissecção simples e rápida, abreviado tempo de internação e baixa morbidade à área doadora, deve ser considerado na reconstrução de feridas oncológicas de diversas localizações, em pacientes de todas as idades