Emergency hand & reconstructive microsurgery in the COVID-19 positive patient

Abstract

The case spectrum in hand surgery is one of extremes – purely elective day surgery cases under local anesthesia to mangling limb injuries that require immediate, and frequently, lengthy, surgery. Despite the cancellation of most elective orthopedic and plastic surgical procedures, hand surgeons around the world continue to see a steady stream of limb9 threatening cases such as severe trauma and infections that require emergent surgical care. With the increase in community-spread, an increasing number of COVID-19 infected patients may be asymptomatic or have mild, non-specific or atypical symptoms. Some of them may already have an ongoing, severe infection. The time-sensitive nature of some of these cases means that hand surgeons may need to operate urgently on patients who may be suspected of COVID-19 infections, often before confirmatory test results are available. General guidelines for peri-operative care of the COVID-19 positive patient have been published. However, our practices differ from general orthopedic and plastic surgery, primarily because of the focus on trauma. This article discusses the peri-operative and technical considerations that are essential to manage the COVID-19 patient requiring emergency care, without compromising clinical outcomes and while ensuring safety of the attending staff.