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

Preoperative Evaluation

If possible, determine the severe acute respiratory syndrome–coronavirus 2 infection status of the patient beforehand. Each institution has its own protocol that can be adhered to. If a patient is positive, a careful assessment of risk to patient and the health care providers should be performed by a multidisciplinary team before the operation is recommended. Operating on mucosal surfaces in a patient who is actively infected generates a significant risk for the entire operating room and recovery units. It may also compromise the patient's ability to recover from the infection.[1]

The current literature also certainly does bring to light the fact that patients with COVID-19 may have a hypercoagulable state, as found in various abnormalities ranging from increased fibrinogen, D-dimer, and factor VIII, to direct endothelial injury. As may be expected because of the more commonly known effects of COVID-19 on the lungs as a target organ, pulmonary microvascular coagulation has been a noted finding. However, more systemic features have been suggested, supported by reports of increased prevalence of venous thromboembolism in the patient population, even despite the use of prophylaxis.[24–26] Given that those who receive microsurgical procedures in particular may be at risk for not only venous thromboembolism but also thrombotic events of the anastomosis and flap itself, the use of venous thromboembolism prophylaxis is especially important when operating on COVID-19–suspected or –confirmed patients. Although there are not yet clear guidelines for venous thromboembolism prophylaxis for the COVID-19 patient, current trials are being conducted to investigate whether higher than conventional doses may be beneficial.