The use of Personal Protective Equipment during the COVID-19 pandemic: The effects on surgical wounds healing after parotid gland surgery.

Dear Sir,

The coronavirus disease 2019 (COVID-19) is a viral infection caused by SARS-CoV-2, which spread around the world from December 2019 and caused over 4 million deaths around the world. Despite advances in pharmacological treatments and the actual coming of the vaccine, self-protection by the use of facemasks still remains the main way to prevent and control the infection and to reduce the transmission of the virus [1]. Compelling data now demonstrate that community mask wearing is an effective nonpharmacologic intervention to reduce the spread of this infection, especially as source control to prevent spread from infected people and as protection to reduce wearers’ exposure to infection [1, 2]. But the use of masks is not without discomfort: Cotrin et al. [2] showed that the patients reported feel shortness of breath, feel discomfort in the ears due to the elastics, dermatitis/skin problems and esthetic issues.

The aim of our study was to underline that the chronic use of mask in patients who underwent to parotid surgery for benign neoplasia with a preauricular approach, seems to retard the surgical wounds healing.

Preauricolar surgical approach to the parotid gland is a very common for the removal of parotid lesions. This approach involves a skin incision in the preauricular region with extension to the ear lobe and continues in the mastoid region according to the type of flap needed for the various types of surgery [3]. This means that both the superior and inferior loop of Personal Protective Equipment (PPE) are in contact with the wound.

Commonly the wound healing consists in four overlapping stages: hemostasis, inflammation, proliferation and finally maturation and/or remodeling. In particular, during the angiogenesis and maturation phases, any trauma to the area of skin involved in surgery will lead to the destruction of the small and delicate sprouting vessels that repopulate the dermis with the result of dehiscence. Any disruptions in healing such as infection or dehiscence itself will lead to a compromised wound that enters a stage of secondary healing, that is more prone to infection and pathological scarring [4].

So, during the pandemic, we observed in the postoperative time a significant increase in dehiscence and inflammation of surgical wounds after parotid gland surgery for benign lesions. In fact we registered 13.75% cases of parotid region dehiscence after benign neoplasia surgery, compared with the literature data of 2–3% of cases [5]. We therefore hypothesized a possible correlation between the frictional trauma due to the loop of the masks and the delay of healing and dehiscence of the surgical wounds of parotid region.

Our hypothesis was supported by the statistical analysis conducted on 154 patients who were treated with a preneural parotidectomy or extracapsular dissection for benign parotid tumors by using a preauricular approaches. These patients were divided into two groups: Group A) 84 patients treated before the pandemic (March 2019-March 2020); Group B) 70 patients treated during the pandemic (March 2020- March 2021) who were therefore forced to wear a mask.

We recorded a total of 3 surgical wound dehiscences in group A and 11 in group B (Table 1 ).

Table 1

 

	No Dehiscences	Dehiscences	Total
Group A (NO COVID-19)	81	3	84
Group B (COVID-19)	59	11	70
Total	140	14	154

The statistical analysis of the data was performed using a chi-square test (Microsoft Excel 16.16.27 Version) and comparing the obtained values ​​with the chi-square standard distribution tables.

We thus obtained that the number of parotid regions dehiscences after surgery, obtained during the pandemic, is statistically higher than in the period preceding the covid-19 (chi-square value 6,81).

Thus we confirmed our hypothesis of correlation between the use of a mask and the parotid region dehiscence: we suggest to our patients to use the PPE with mask loop clips, or extenders, to avoid any frictional trauma that can retard healing wounds.

Declaration of Competing Interest

None declared.