“Plastic Surgery practices amidst global COVID-19 pandemic: Indian consensus”

Agarwal, Rajiv; Singhal, Maneesh; Shankhdhar, Vinay Kant; Chittoria, Ravi Kumar; Sahu, Ranjit Kumar; Singh, Veena; Chandra, Ramesh

INTRODUCTION: The COVID-19 pandemic having spread globally has profound implications on the medical and surgical care which is given by the health care providers. At this time though there are guidelines and recommendations for medical management of these patients, there is a lack of guidance on how should a plastic surgeon approach the COVID-19 suspect or infected patient who presents either in elective or emergency setting. We aim to provide a consensus guideline based on the current recommendations of the Indian Council of Medical Research (ICMR) and the pooled experience of the major centers performing plastic and reconstructive surgery in India. METHODS: The current guidelines and recommendations on the COVID-19 pandemic were studied from both government and non-government sources including ICMR. The problems in the specialty of plastic surgery were categorized into four groups and for each group, separate and individual guidelines have been worked out. GUIDELINES: Consensus guidelines have been formulated for the specialty of Plastic and Reconstructive surgery. The patients requiring plastic surgery service have been categorized into four groups of acute, subacute, chronic and late category. Acute cases are the ones who require intervention within 24-48 hours. Subacute cases are the ones who require intervention in the next 3-10 days while the chronic are the ones who need plastic surgery preferably within a month. The late category are the ones who need surgery within the next six months. This has been done based on the urgency and priority of surgical intervention titrated against the risks of operating and inadvertently acquiring exposure of COVID-19 positive patients. CONCLUSION: Currently in the wake of COVID-19 pandemic there are no clear guidelines specific to the vast majority of patients who come for a plastic surgery intervention. This puts the patients at risk due to the impending plastic surgery problem while at the same time poses risk of exposure to COVID-19 for the surgical team. A consensus guidelines are presented to steer the plastic surgeon in his work in the wake of COVID-19 crisis. The guidelines are based on firm scientific evidence from the reputed research and regulatory bodies and have been made in consonance with plastic surgery experts around the country so that these practices best suit the needs of the patients while being mindful of resource limitations and infection risks. The approach of “delayed conservative treatment” works best in present case scenario.