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Plastic Surgeons in Action against Coronavirus Disease 2019 at the First Coronavirus-specialty Hospital in Europe

Stabile, Marco MD; Rosato, Luca MD

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Plastic and Reconstructive Surgery - Global Open: June 2020 - Volume 8 - Issue 6 - p e2998
doi: 10.1097/GOX.0000000000002998
  • Open
  • Italy


We are in Castel San Giovanni (30 km from the epicenter of the Tsunami, Codogno), and the entire hospital has been transformed into a coronavirus specialty hospital. From one day to the next, all the activities have been cancelled, and all the staff made themselves available to the wave of patients who were coming.

Our operating rooms have been immediately reconverted and transformed into a respiratory therapy intensive care unit. It was the first hospital to handle coronavirus cases in Europe. As voluntary plastic surgeons, we have been involved in humanitarian missions in Africa and South America for years, for which we were “forged” to operate in emergency situations. This was the worst experience.

It was like being in a military hospital during a war, where the patients came wounded from the front. From the 29th of February, the ambulances were left in the emergency department, with their sirens blaring; there were dozens of patients with varying degrees of illness, with some in desperate conditions. Fever, cough, low saturation, and air hunger were the most frequent signs. High-resolution computed tomography scan images of patients showed interstitial pneumonia with a characteristic “ground glass” appearance.

We organized ourselves with all the medical staff to provide the best possible care for the patients. We learned to protect ourselves with the devices provided by the hospital.

We are plastic surgeons, and we have always been used to wearing masks, but filtering face piece (grade 2) (FFP2) masks are something else. With FFP2 masks, breathing becomes more difficult, and wearing them for 10 hours creates problems: the masks’ elastic bands tighten the face, the dorsum of the nose gets red, and often becomes painful. We have learned to evaluate the P/F ratio (PaO2/FiO2 ratio), which makes you understand how “the patient breathes”: below 100, it must be intubated; between 200 and 300, it goes in noninvasive ventilation (NIV) Helmet; and above 300, it can be enough to have the oxygen supplied with mask and reservoir.

Being dressed up in protective suits does not make the work particularly comfortable; wearing such suits, working several hours in the hospital, you may be sweating up to dehydration. The fear of having some skin part exposed to coronavirus contagion is palpable.

The corridors of the ward are empty; all the operators in the wards are taking care of the patients; and only the alarms and the noise of the oxygen dispensers functioning in high pressure can be heard. This is an impressive and disheartening situation.

The situation is much worse in the rooms of patients wearing NIV helmets because they cannot hear what you say to them because of the high flow of oxygen spinning from above their heads. We understood each other by gestures. We have learned how to manage NIV helmets, and we have made ourselves available to act as a “human mannequin” to explain to the staff how to prepare a helmet on the patient, how to manage the openings, and how to regulate the flow of oxygen (Fig. 1). It is not easy to stay there for hours, I can assure you. Your eardrums hurt because of the increased pressure from the high oxygen flow; you can only hear the noise of the oxygen vortex around you, and it prevents you from hearing the outside world. Under your armpits, the tie rods are tightened to maintain the helmet’s adhesion to your neck; you cannot touch your face or your head. You cannot wear glasses; so, if you have a visual impairment, you cannot see well.

Fig. 1.
Fig. 1.:
Marco Stabile, MD, wears the noninvasive Helmet to show how to manage it on patient.

As plastic surgeons, we positioned dozens of arterial Seldinger to avoid pricks of the arms 2 or 3 times a day to control the blood gas test. Every day, we visit the patients, all of them bedridden and confined to their rooms (Fig. 2). Saturation and temperature are measured. A word of comfort is brought to them; they are alone and scared, and they do not talk to anyone for days. In hospital rooms, there is no longer the distinction between men and women; promiscuity is the norm, and nobody pays attention to it anymore. They often ask you how the healing is progressing, and if it is still long, you read fear in their eyes.

Fig. 2.
Fig. 2.:
The Plastic Surgery Team at work during the war against COVID-19. COVID-19 indicates coronavirus disease 2019.

There were many deceased patients during the first few days, and we cried several times. There is that sense of helplessness when the exitus comes, but also the awareness of having given everything and of having sought the least suffering for them. We answered the phone calls of the relatives, their only voice one of hope.

Solidarity between colleagues is palpable; one feels the closeness, the desire to help, and to make oneself available for everything. We have been called in to treat the skin pressure sores of intubated patients. We were surprised to realize that they were not sacral, but on the face. In patients pronated for 10 hours, they are frequently on the chin, nose, cheekbones, and forehead above the eyebrows.

Summing up this experience, we can say we have grown up; we have appreciated more what it really means to be a doctor: a wonderful profession.


The authors have no financial interest to declare in relation to the content of this article.

Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.