key: cord-285207-hsbzcpl3
authors: Facchin, Federico; Messana, Francesco; Sonda, Regina; Faccio, Diego; Tiengo, Cesare; Bassetto, Franco
title: COVID-19: Initial experience of hand surgeons in Northern Italy
date: 2020-05-04
journal: Hand Surg Rehabil
DOI: 10.1016/j.hansur.2020.04.007
sha: 
doc_id: 285207
cord_uid: hsbzcpl3

nan

We are grateful to Ducournau et al. for sharing how an international group of hand surgeons managed surgery during the COVID-19 pandemic [1] . This event has severely affected many countries worldwide [2] . After the first Italian death due to COVID-19 in Vò, the Italian healthcare system managed to limit the diffusion and deadliness of the virus [3].

Our facility is a hand trauma referral center in Northern Italy that sees more than 700 trauma cases/year. We agree with the need for an international consensus and we would like to report our initial experience. Our healthcare facility created an internal study group called Plastic Surgeons Against COVID-19 (PSAC) to deal with specific issues related to the pandemic [4] .

Preventive measures are needed to ensure the safety of patients and healthcare workers, to provide emergency treatment during the peak of the pandemic, and to schedule non-emergent procedures in the next months. Respecting social distancing, limiting meeting time and using personal protective equipment (PPE) allowed all of our unit's surgeons and staff to avoid SARS-CoV-2 infection, as confirmed by the more than 100 negative swabs tested [4] .

An analysis of the cases treated in one month from the beginning of the lockdown (9 th March -9 th April 2020) confirmed the impact of COVID-19 in hand surgery and dictated the need for precise screening to limit the spread of the infection (Table 1) . To our surprise, the number of hand injuries was similar to the same period over the prior three years, despite the suspension of many work activities and millions of people being forced to stay home. In fact, we witnessed a slight relative increase in home-related injuries in 2020.

All elective hand surgeries (**see Table 1 ) were cancelled except for non-emergent posttraumatic and oncologic procedures. Outpatient office visits were reduced to only posttraumatic and oncologic preoperative cases and essential follow-up. Fortunately, postoperative physiotherapy counseling has always been available.

According to our data, hand injuries remain a major healthcare issue during a pandemic.

Also, sooner or later, we will have to deal with all the postponed elective patients. We agree that hand surgery units need to share COVID-19 preventive protocols to allow elective and non-elective procedures to continue safely. We believe that all patients should ideally undergo a screening test for the virus, and we advocate for wider test availability and faster results [5] . In the middle of this crisis, we developed a screening protocol for safe and systematic organization of the required activities (Fig. 1) .

Given their role in such important period, hand surgery units should share their protocols and their know-how to develop an international consensus in face of the current pandemic.

Besides, we should be prepared to gradually restore the pre-COVID surgical regimen while doing all we can to limit the second wave of contagions expected once the lockdown is over.

The authors declare they have no competing interest related to this article. 

COVID-19: Initial experience of an international group of hand surgeons

Effectiveness of preventive measures against Covid-19 in a Plastic Surgery Unit in the epicenter of the pandemic in Italy

Estimated effectiveness of symptom and risk screening to prevent the spread of COVID-19