A Multidisciplinary Approach and Review of Safety Recommendations for Plastic Surgeons During the COVID-19 Pandemic

Are N95 Masks Enough?

Scharukh Jalisi, M.D., M.A.; Austin D. Chen, M.D.; Ernest Gomez, M.D.; Radhika Chigurupati, D.M.D.; Ryan Cauley, M.D., M.P.H.; Suzanne Olbricht, M.D.; Bernard T. Lee, M.D., M.B.A., M.P.H.; Samuel J. Lin, M.D., M.B.A.


Plast Reconstr Surg. 2021;148(2):467-474. 

In This Article

Abstract and Introduction


The novel coronavirus disease of 2019 pandemic presents a unique challenge to the field of plastic and reconstructive surgery. Although plastic surgeons may be postponing elective operations, there are still a number of emergent or urgent procedures that may need to be performed, and surgeons may be facing the reality of returning to a new normalcy of operating with coronavirus disease of 2019. These procedures, consisting of those such as head and neck reconstruction or maxillofacial trauma, largely require a multidisciplinary approach and may be considered of higher risk to health care workers because of the involvement of areas of the body identified as sources for viral transmission. Moreover, viral transmission may potentially extend beyond respiratory secretions, which has been the main focus of most safety precautions. The authors aim to present the scope of these procedures and the means of viral transmission, and to provide safety precaution recommendations for plastic surgery and its related disciplines.


The novel coronavirus disease of 2019 (COVID-19) pandemic presents a unique challenge to the field of plastic and reconstructive surgery, a discipline that also interfaces with otolaryngology–head and neck surgery, Mohs micrographic surgery, and oral and maxillofacial surgery. Several societies have provided their guidelines about safety.[1–4] Although evolving recommendations provide an overview of specialty-specific guidelines, they are not geared toward plastic surgeons in urgent or emergent cases, or when returning to a new normalcy of operating despite the COVID-19 pandemic.

The specific transmission rate to health care workers is not yet known; however, health care workers likely have at least a three-fold increase in the risk of infection compared to the general public based on data from China and Italy.[5] Even in the event of providers testing positive for antibodies, there is not enough information at the present time to know the duration of these antibodies or the extent of protection from future infections. As such, the providers should still take appropriate safety precautions regardless of COVID-19 antibody status. As surgeons, we have a dual responsibility to provide appropriate treatment to our patients while taking care to prevent transmission.[2] Safety is paramount to continue providing appropriate care to patients with and without COVID-19. Aside from conventional routes of viral transmission through airborne droplets, we review other potential forms of transmission in the form of aerosolized viral titers created by electrocautery.