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Introduction: Basal cell carcinoma (BCC) is a locally invasive, slowly spreading tumor arising in the basal layer of epidermis and rarely metastasizes. Surgical excision with adequate margins is curative. Reconstruction of post-excisional defects on the face is both essential and challenging. Clinical Cases and Methods: A retrospective review of hospital records for patients operated for BCC of the face excluding the pinna at our institute in the last 3 years was done and a review of the literature was carried out to identify the most common principles governing the optimal reconstruction of post-excisional defects on the face. Literature search was made in Embase, Medline, and Cochrane databases in the last two decades with the filters placed for human and English language studies with the search terms (Facial Basal cell carcinoma) AND reconstruction AND (Humans[Mesh]). Results: Records of 32 patients with facial BCC who underwent excision and reconstruction at our hospital were identified and details were recorded. Our literature search with the terms and filters mentioned above revealed 244 studies with duplicates removed. After further hand-searching, 218 journal articles were identified, reviewed, and a reconstruction algorithm was designed based on the findings. Discussion: Reconstruction of post-BCC excisional defects of the face relies on an adequate understanding of the general principles of reconstruction, subunit principle of facial esthetics, flap anatomy and vascularity as well as operator experience. Complex defects need innovative solutions, multidisciplinary approaches, and newer methods of reconstruction like perforator flaps and newer techniques like supermicrosurgery. Conclusion: Multiple reconstructive options for post-excisional defects of the BCC over the face are available and most defects can be approached in an algorithmic manner. Further well-designed prospective research studies are needed to compare outcomes of different reconstructive options for a given defect and identify the most suitable options.
RESUMO
Introduction The study was carried out to quantify the changes induced by the pandemic in plastic surgery practice and training and to study the impact of the webinars on plastic surgery education from a residents' perspective. Methods In this multicentric study, the number and type of surgeries, cause of injuries, and their regional variation during the coronavirus disease 2019 (COVID-19) period (February-September 2020) were compared with pre-COVID-19 time. An online survey on the impact of webinars was conducted for plastic surgery trainees across the country. Results There was a significant reduction in total number of surgeries ( p = 0.003). The procedures for hand ( p = 0.156), faciomaxillary injuries ( p = 0.25), and replantations ( p = 0.46) were comparable; there was a significant reduction in combined orthopedic-plastic-surgical procedures ( p = 0.009) during the pandemic. There was a significant reduction in road accidents ( p = 0.007) and suicidal injuries ( p = 0.002) and increase in assault ( p = 0.03) and domestic accidents ( p = 0.01) during the COVID-19 period. A usefulness score of >8 was given for the webinars by 68.7% residents. There was no significant difference in perception of utility when correlated with the academic program at their institutes ( p = 0.109); 92% opined webinars should continue in post-COVID times. Conclusion There was a drastic reduction in number of elective and emergency procedures during the COVID-19 time, negatively affecting resident training program. Majority of residents felt that webinars could prove a useful adjunct to training in formal training program in post-COVID-19 scenario.
