The Safe Resumption of Elective Plastic Surgery in Accredited Ambulatory Surgery Facilities During the COVID-19 Pandemic.

BACKGROUND: On March 11, 2020, the World Health Organization declared the novel Coronavirus-19 (COVID-19) a worldwide pandemic, resulting in an unprecedented shift in the Canadian healthcare system, where protection of an already overloaded system became a priority; all elective surgeries and non-essential activities were ceased. With the impact being less than predicted, on May 26, 2020, elective surgeries and non-essential activities were permitted to resume. OBJECTIVES: The authors sought to examine outcomes following elective aesthetic surgery and the impact on the Canadian healthcare system with the resumption of these services during the COVID-19 worldwide pandemic. METHODS: Data were collected in a prospective manner on consecutive patients who underwent elective plastic surgery procedures in 6 accredited ambulatory surgery facilities. Data included patient demographics, procedural characteristics, COVID-19 polymerase chain reaction (PCR) test status, airway management, and postoperative outcomes. RESULTS: A total of 368 patients underwent elective surgical procedures requiring a general anesthetic. All 368 patients who underwent surgery were negative on pre-visit screening. A COVID-19 PCR test was completed by 352 patients (95.7%) and all were negative. In the postoperative period, 7 patients (1.9%) had complications, 3 patients (0.8%) required a hospital visit, and 1 patient (0.3%) required hospital admission. No patients or healthcare providers developed COVID-19 symptoms or had a positive test for COVID-19 within 30 days of surgery. CONCLUSIONS: With appropriate screening and safety precautions, elective aesthetic plastic surgery can be performed in a manner that is safe for patients and healthcare providers and with a very low risk for accelerating virus transmission within the community.

Skin rejuvenation and wrinkle reduction using a fractional radiofrequency system.

INTRODUCTION: Skin resurfacing has evolved rapidly over the past 15 years from ablative techniques to nonablative methods and most recently fractional ablative resurfacing. The purposes of this study were to analyze the degree of tissue ablation, coagulation, and heating; and to evaluate the clinical efficacy and safety of a fractional radiofrequency (RF) device, for the treatment of wrinkles with fractional skin ablation and coagulation. MATERIAL AND METHODS: Individuals scheduled for abdominoplasty received fractional RF treatment to the abdomen area, using different tips at varying energy densities and coverage rates. Biopsies were performed ex vivo following abdominoplasty and tissue samples were routinely processed and stained, using hematoxylin and eosin). Another group of subjects received 3 facial treatments, scheduled at 3 to 4 week intervals. Clinical improvement and response to therapy were evaluated with standardized photography and clinical assessment by the subjects and investigators. RESULTS: Histological findings immediately posttreatment revealed demarcated zones of ablation/coagulation/necrosis and subnecrosis up to a depth of 450 microm. Higher energy levels generated deeper effects. We noticed a tunable balance between ablation and coagulation/necrosis. These effects were coverage mode and energy density dependent. Subjects undergoing facial treatment had minimal pain, no permanent side effects, or significant downtime. Investigators' assessment for improvement in skin texture correlated with subjects' evaluation and was greater than 40% for approximately 50% of subjects. Eighty percent of the subjects were satisfied with the results. Higher energy levels and lower coverage rates produced better aesthetic results along with less pain. CONCLUSION: The clinical observations and histological findings suggest that fractionated ablative skin resurfacing using a fractional radiofrequency device resulted in a safe, tolerable and effective improvement in skin texture and reduction of wrinkles. The depth of tissue ablation, coagulation and necrosis and the relative proportions of these phenomena were found to be controllable and could be modulated to optimize treatment of variable dermatologic conditions.

Prehospital prediction of the severity of blunt anatomic injury.

OBJECTIVES: To evaluate the ability of paramedics to predict patients requiring a major trauma service. To assess whether paramedic prediction of severity of injury to individual body regions is accurate and could add to overall paramedic prediction of injury severity. METHODS: Helicopter paramedics in Victoria prospectively recorded the severity of injury to the head, thoracic, and abdomen regions, and whether the patient required a major trauma service, for primary response adult (>15 years) trauma patients. Paramedic predictions of injuries were compared with patient outcomes. Major trauma was defined as death in hospital; an Injury Severity Score >15; intensive care unit admission >24 hours; and urgent surgery. A severe anatomic injury was defined as an Abbreviated Injury Scale severity >/=3. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS: Two hundred and seven patients were enrolled in the study, with 62.3% defined as major trauma. The sensitivity of paramedic predictions ranged from 57.6 (95% confidence interval [CI]; 45.4-68.9) for the head to 38.5 (95% CI; 22.1-57.9) for the abdomen. Specificities ranged from 98.3 (95% CI; 93.5-99.6) for the thorax to 93.5 (95% CI; 87.9-96.6) for the head region. The sensitivity and specificity of paramedic predictions of a major trauma status were 97.7 (95% CI; 93-99.2) and 28.2 (95% CI; 19.3-39.1), respectively. The paramedics correctly categorized all patients who were admitted to an intensive care unit, required urgent surgery or died in hospital as major trauma. CONCLUSIONS: Paramedics were unable to reliably identify severe injury to individual body regions. Sensitivity of paramedic judgment of major trauma status was high. Assessment of the severity of injury to individual body regions did not appear to improve accuracy.

Is paramedic judgement useful in prehospital trauma triage?

Precise prehospital trauma triage criteria are critical for ensuring patients with severe injuries are transported to trauma centres. Most prehospital trauma triage criteria adopt a combination of physiological, anatomic and mechanism of injury components, but this approach still fails to identify a number of patients with severe injuries and often burdens trauma centres with patients suffering minor injuries. Paramedic judgement has been identified as an alternative method for the triage of trauma patients. This study critically reviewed the literature regarding the ability of paramedics to predict injury severity, and found there is no clear evidence supporting paramedic judgement as an accurate triage method. However, the studies were limited due to significant data losses, variable definitions of major trauma, differences across EMS and trauma care systems, variable paramedic experience levels and incomparable methods of data collection. The role of paramedic judgement in identifying patients with severe blunt anatomic injuries requires further investigation.

Photodestruction of human dental plaque bacteria: enhancement of the photodynamic effect by photomechanical waves in an oral biofilm model.

BACKGROUND AND OBJECTIVES: Periodontal disease results from the accumulation of subgingival bacterial biofilms on tooth surfaces. There is reduced susceptibility of these biofilms to antimicrobials for reasons that are not known. The goals of this study were to investigate the photodynamic effects of a conjugate between the photosensitizer (PS) chlorin(e6) (c(e6)) and a poly-L-lysine (pL) with five lysine residues on human dental plaque bacteria as well as on biofilms of the oral species Actinomyces naeslundii after their exposure to photomechanical waves (PW) generated by a laser in the presence of the conjugate. STUDY DESIGN/MATERIALS AND METHODS: Subgingival plaque samples from 12 patients with chronic destructive periodontitis were divided in 3 groups that were incubated for 5 minutes with 5 microM c(e6) equivalent from the pL-c(e6) conjugate in the presence of fresh medium (group I), PBS (group II), and 80% PBS/20% ethylenediaminetetra-acetic acid (EDTA) (group III) and were exposed to red light. Also, biofilms of A. naeslundii (formed on bovine enamel surfaces) were exposed to PW in the presence of 5 microM c(e6) equivalent from the pL-c(e6) conjugate and were then irradiated with red light. The penetration depth of the conjugate was measured by confocal scanning laser microscopy (CSLM). In both cases, after illumination serial dilutions were prepared and aliquots were spread over the surfaces of blood agar plates. Survival fractions were calculated by counting bacterial colonies. RESULTS: The PS/light combination achieved almost 90% killing of human dental plaque species. In biofilms of A. naeslundii, CSLM revealed that PW were sufficient to induce a 50% increase in the penetration depth of the pL-c(e6) conjugate into the biofilm. This enabled its destruction (99% killing) after photodynamic therapy (PDT). CONCLUSIONS: PW-assisted photodestruction of dental plaque may be a potentially powerful tool for treatment of chronic destructive periodontal disease.