Impact of COVID-19 pandemic on plastic surgery activities and residency programs in a tertiary referral centre in Iran.

Background: On March 11, 2020, the World Health Organization (WHO) announced the COVID-19 outbreak as a new pandemic. In the meantime, plastic surgeons postponed their appointments due to the fair and rational allocation of medical supplies. These limitations made all junior and senior residents perform operations only on traumatic patients rather than those needing reconstructive procedures. This study aims to determine the effects of the COVID-19 pandemic on plastic surgery training programs in Iran. Also, the number of canceled surgeries will be determined to see the effects of the pandemic on the patients. Methods: This retrospective case study considers a six-month timeframe in two consecutive years before and after the COVID-19 pandemic. For this purpose, the researchers evaluated the number of surgeries, types of procedures, age distribution, and gender distribution. The training program data of plastic surgery residents were collected from their logbooks and then analyzed in IBM SPSS Statistics 26. Differences were considered significant if p < 0.05 at a 95% confidence level. Results: The total number of surgeries decreased by 23.5% after the COVID-19 outbreak (p < 0.05). There was a 29.9% reduction in trauma cases, -78.9% in aesthetic surgeries, -17.7% in reconstructive surgeries, -51.8% in craniofacial surgeries, and -59.5%in microscopic surgeries for each resident. Conclusions: This study provides an insight into the severity of the pandemic effects on the plastic surgery training programs and the patients. The reduced number of surgeries led to a depletion in surgical skills training. These effects will not wear off immediately after the pandemic; therefore, it is necessary to observe whether the pandemic will have any lasting effects on this subspecialty.Level of evidence: Level IV, risk/prognostic study.

The Incidence of Ossified Superior Transverse Scapular Ligament during Nerve Transfer through Posterior Shoulder Approach.

BACKGROUND: The purpose of this study was to assess the incidence and importance of bony bridge that covers the supra scapular notch during posterior approach to transfer accessory nerve to suprascapular nerve. METHODS: Between 2010 and 2015, the frequency and importance of suprascapular bony bridge instead of transverse ligament was assessed among patients with brachial plexus injury candidate to shoulder function restoration by accessory to suprascapular nerve transfer through posterior approach. RESULTS: Forty three patients, 41 male and 2 female, (mean age: 32.5 years, range 14 to 36) were included in this study. Five male patients (11.6%) had a complete bony rim on the superior scapular notch. Suprascapular nerve release needed osteotomy of the bony bridge and related equipment. CONCLUSION: Although all previous cadaveric studies among different ethnic groups had reported the prevalence between 0.3 to 30% of suprascapular canal, this in vivo study showed the incidence of 11.6%. Preoperative alertness about this variation could make the exploration and release of the suprascapular nerve easier and reduce the risk of nerve injury or failing to anatomize it. LEVEL OF EVIDENCE: IV.

Cell-based skin substitutes accelerate regeneration of extensive burn wounds in rats.

BACKGROUND: This study investigated the effects of amniotic membrane combined with adipose-derived stem cells or fetal fibroblasts on regenerating extensive burns in rats. METHODS: Third degree burns of 1100-1800 mm2 were induced on 32 Sprague-Dawley rats. Burned sites were excised and randomly covered with Vaseline gauze (control), human amniotic membrane (HAM), human fetal fibroblasts seeded on HAM (HAM-FF), or human adipose-derived stem cells seeded on HAM (HAM-ASC), and followed by wound closure and histological assessments. RESULTS: Wound closure rates of HAM-FF, HAM-ASC, HAM and control groups at seven and 14 days after the treatment were 42.2% and 81.9%, 41.9% and 81.7%, 33.5% and 74.2%, and 16.5% and 69.7%, respectively. Wounds of HAM-FF, HAM-ASC, HAM and control groups were closed on 40, 40, 50 and 60 days after the treatment, respectively (P < 0.05). Histological assessments revealed lower inflammatory cell infiltration in HAM-ASC and HAM-FF groups. CONCLUSIONS: Cell-based engineered skin substitutes seem to accelerate wound regeneration, especially within the first 14 days.