Plastic surgery in the time of Coronavirus in Italy. Can we really say "Thanks God we are plastic surgeons?"

Dear Sir

We may all imagine how things go when a huge tragedy like that of COVID-19 hits on the health care system of a country. Medical and surgical specialties live as they are in a “parallel world”, which exists alongside the Intensive Care Units, the Departments of Infectious Disease, Pneumology, Hygiene and all the buildings which have been converted in COVID buildings in order to assist infected or suspected of being infected people. The most difficult prediction is the maximum number of infected patients that will be reached in Italy and, most importantly, the maximum number of patients who will require intensive care unit admission.

The social significance of the almost heroic task of those who fight the virus, fighting against time, and the treatment strategies to be invented persuade that this is the only medical battle to be won. We certainly cannot blame it: the coronavirus is the game of life but also the game of medical science.

But who is on the other side?

If the coronavirus dictates the planetary health agenda, certainly the other disciplines, alas, do not live between reality and memory. The idea of a certain snobbery towards some surgical branches such as plastic surgery does not really coincide with the sudden increase in specific surgical cases. Indeed, it is curious to observe how the urgent provisions concerning the contrast and containment of the spread of the COVID-19 virus issued by the Italian Government with the DD.PP.CC.MM. of 08.03.2020 and 09.03.2020 may have influenced this trend.

Something has changed since people have been forced at home, wondering what to do.

We reviewed the data of all the patients admitted to our Plastic Surgery Unit, which is located in a COVID hospital, from our institution digital databases from the 1st to the 31st of March 2020 and we compared those data with the ones of the previous 5 years. In accordance with the Circulars of the Ministry of Health, the ordinary hospitalization and outpatient activities have all been remodulated in order to meet the potential increase in hospitalization needs and to limit patient flows within the care facilities. Only urgent or emergency surgery or not postponable oncologic surgery have been guaranteed. As a matter of fact, the number of total admissions in our Unit demonstrated a reduction rate of 85% (Figure 1 ). On the other hand, the results of the statistical analysis for the month under review has shown that hand trauma related to home accidents have raised of 15.8% on average compared to the same period of the previous five years. This figure has been essentially the result of clumsy experiments with tutorials for carpentry works of all kinds, bricolage and gardening, with the milder weather as an excellent ally (Figure 2 ).

Figure 1.

Comparison of the total admissions in Plastic Surgery Unit between March 2020 and March 2015-2019 (average value).

Figure 2.

Comparison of admissions for home hand accidents between March 2020 and March 2015-2019 (average value).

The anxiety and the fear of contagion have led many to do-it-yourself for the sanitization of environments and the hygiene of hands and clothes. Quite for this reason, ten patients were admitted to our Burn Center this month alone. The 67% of the patients were treated for burns caused by denatured alcohol, while in the 33% of the cases, the injury was caused by the improper use of corrosive substances, awkwardly used for the artisanal realization of disinfectants. The total number is 22% higher than the five years before.

Not even the prison system has remained foreign to the previous observations, with reference to patients who had needed recovery and treatment in a plastic surgery department. Riots in Italian prisons hit the headlines after the Italian Government decision to discontinue visiting from relatives. Maxillofacial trauma admitted to the selected Departments raised from the last 5 years of 35%.

The Plastic Surgery Community continues to work and to fight the same universal battle with the same sense of responsibility. Responsibility to be part of the cure and not part of the disease. For instance, dedicated plastic surgery teams comprising attending physicians and residents have been established in our Center. They do not come into contact with each other and alternate on a weekly basis. We should be role models for good hand hygiene and enforce strict compliance to minimize disease spread and not add to the general hysteria.

Declaration of Competing Interest

None.