Plastic surgery emergency surgical care during the COVID-19 lockdown at a Mexico City academic center.

Dear Sir,

Even though reopening has begun in several European and Asian nations, Latinamerican countries still show an increase in COVID-19 cases. Plastic surgeons and training programs have been severely affected due to the cancelation of elective procedures in this scenario. Recent reports have shown an important decline in elective procedures during lockdown, with slow uptake after reopening.

Hospitals have turned their attention towards the management of COVID-19 patients, however several institutions continue to provide specialized care for emergency situations such as hand trauma, burns, facial fractures, or chronic wound management. Information about plastic surgery-related emergency procedures during lockdown is scarce. We aimed to compare our productivity before and during lockdown at a plastic surgery referral center in Mexico City.

A retrospective review was performed including patients treated by a plastic surgeon at our institution's emergency department during the fourteen-week lockdown period in Mexico City (March 23rd to June 28th 2020), and compared those results with the same date period from the previous year.

In 2019, 1114 patients were treated, while only 393 cases were seen in 2020. Upper extremity trauma was the most common type of injury (712 cases in 2019 and 228 in 2020), followed by facial trauma (348 cases in 2019 vs 131 in 2020). The distribution of minor injuries requiring repair under local anesthesia did not differ much (75.3% in 2019 and 73.3% in 2020), however the proportion of procedures requiring admission to the operating room rose from 3.11% in 2019 to 8.11% in 2020. Interestingly, during the lockdown period consultations for pressures sores rose from 0.1% to 1% of the total consultations.

Emergency surgical productivity showed a 65% reduction during the COVID-19 lockdown. When compared to other series, such as the one by Wang et al., we had an even deeper decrease in productivity (53% vs 65%). This reduction in the need for surgical attention can be partially explained by the overall diminished economical activity, leading to less work-related accidents, as well as a reduction in outdoor physical activities and motor vehicle accidents. Another factor could be that the largest public hospitals in Mexico City were turned into COVID-19 attention centers, driving people with emergency needs away from them.

These results further complicate the scenario for practicing plastic surgeons and residents in training, adding to the decrease in elective surgery and non-invasive procedures. It has been shown that a decline in elective and emergent surgical exposure negatively impacts resident's abilities and confidence; meanwhile, such a severe reduction in trauma call damages one of the last sources of income for practicing surgeons.

During this difficult time education programs should promote learning by adopting new telecommunication and simulation technologies. As reopening is implemented the need for emergency surgical procedures will surely rise, and plastic surgeons in Mexico and abroad should be ready to meet the demand, while following national and international safety guidelines (Table 1) .

Table 1

Summarization of Emergency Cases in PRS Department during the COVID-19 Pandemic.

	2019	2020
Gender, n (%)
Male	743 (66.7%)	275 (70.6%)
Female	369 (33.2%)	114 (29.3%)
Area, n (%)
Face	348 (31.3%)	131 (33.3%)
Arms	712 (63.9%)	228 (58%)
Legs	42 (3.8%)	22 (5.6%)
Other	12 (1.1%)	12 (3.1%)
Surgical type
Minor	839 (75.3%)	287 (73.3%)
Major	35 (3.1%)	32 (8.1%)

Declaration of Competing Interest

None.