Atodaria PR, et al., Archiv Surg S Educ 2021, 3: 024 DOI: 10.24966/ASSE-3126/100024

HSOA Archives of Surgery and Surgical Education Review Article

easy to make, replicable, cost effective, facilitates accommodating Customized Facial Protection the loupe optic system into it and prevent fogging. Keywords: Corona virus; COVID-19 pandemic; Facial protection Shield during COVID-19 shield; Fogging; Personal Protection Equipment (PPE); Surgical Pandemic to Protect Surgeons loupes Wearing Surgical Loupes Objective The aim of the indigenous customized facial shield was to provide While Performing Surgical the surgeons adequate protection while performing (emergency) surgical procedures of micro-vascular trauma, hand injuries and Procedures facial poly-trauma, with the incorporation of loupe optic system into Pradipkumar R Atodaria1*, Kuldeepsinh P Atodaria2, Viralkumar the shield. The same customized facial shield can be adapted to be Dineshchandra Patel3, Nikunj Vithalani4, Vani Rajesh Jain5, used for routine works by surgeons of other specialties necessitating Ruchik Shirish Kevadiya5 and Harsh Pradipkumar Atodaria6 wearing surgical loupes during the COVID-19 pandemic. 1Cosmetic Surgeon, Atodaria Hair Transplant & Cosmetic Surgery Center, Gujarat, India Background

2Medical Officer, Atodaria Hair Transplant & Cosmetic Surgery Center, The novel Corona Virus SARS-CoV-2 (COVID-19) was Gujarat, India identified in early December in Wuhan, China [1]. The World

3 Health Organization (WHO) declared Corona Virus disease 2019 Consultant Plastic Surgeon, Department of Plastic Surgery , Bharat Cancer (COVID-19) a global pandemic on March 11, 2020 classifying the Hospital & Research Institute, Gujarat, India outbreak as an international emergency. In accordance with the 4Consultant Cancer Surgeon, Department of Cancer Surgery, Bharat directive from the Indian Government and guidelines from the Indian Cancer Hospital & Research Institute, Gujarat, India Medical Association all elective surgeries were discontinued during 5Medical Officer, Harsiddhi Cosmetic & Plastic Surgery Hospital, Ring Road, lockdown. The major challenges faced by most surgeons including the Gujarat, India authors was, to be adequately protected while performing emergency surgical procedures for micro-vascular trauma, hand injuries and 6Director, Atodaria Hair Transplant & Cosmetic Surgery Center, Ghod-Dod facial poly-trauma [2-4]. Non availability of adequate supply of road, Athwa Lines,Surat, Gujarat, India Personal Protection Equipment added to the difficulties. Micro-vascular repair, crush injuries of hand and poly-traumatic Abstract facial injuries are time-consuming surgeries. Proper illumination and The novel Corona Virus SARS-CoV-2 (COVID-19) was identified magnification with surgical loupes are imperative for most of these in early December 2019 in Wuhan, China. During the COVID-19 [5,6]. For the safety of surgeons and health care workers from droplet- pandemic, the elective surgeries were discontinued completely as transmitted infections, a set of personal protection guidelines for health per the Government directive and advisory from the state medical personnel responding to the COVID-19 epidemic were published by councils. The emergency procedures required appropriate Person- al Protection Equipment (PPE) including face shields and masks. Chinese physicians. It was recommended that personal protective For emergency micro-vascular trauma, crush injuries and facial po- equipment of various levels should be used as appropriate [7]. The ly-trauma surgeries, loupe magnification is required. Magnification available Personal Protective Equipment (PPE) with the protective loupe optic systems were not possible to be accommodated in the eye glasses is not very accommodating to the use of surgical loupes. shield or visors used for facial protection from the novel corona vi- Other options tried were, using a visor of a helmet on top of the loupes rus aerosol infection. The customized facial shield is a comfortable, but it causes additional pressure transmitted to the surgeon’s nose and forehead with reduced visibility due to fogging. The limiting factor of *Corresponding author: Pradipkumar R Atodaria, Cosmetic and Plastic moving visor glass further away from the face was decreased stability, Surgeon, Atodaria Hair Transplant & Cosmetic Surgery Center, Gujarat, India, and compromised protection. E-mail: [email protected]

Citation: Atodaria PR, Atodaria KP, Patel VD, Vani N, Jain VR, et al. (2021) Innovation & Technique Customized Facial Protection Shield during COVID-19 Pandemic to Protect To overcome the above-mentioned concerns, the authors looked Surgeons Wearing Surgical Loupes While Performing Surgical Procedures. Archiv Surg S Educ 3: 024. for a solution to provide customized complete facial protection, utilizing commonly available materials. The authors’ “indigenous Received: May 26, 2021; Accepted: June 04, 2021; Published: June 14, 2021 face shield” was made using Over-Head Projector (OHP) plastic sheets. This material was found to be easy to work with, sturdy Copyright: © 2021 Atodaria PR, et al. This is an open-access article distributed enough to stay in place and has excellent transparency. Four apertures under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the were punched at appropriate distances at the upper edge of the sheet original author and source are credited. to accommodate the thread/string which is used to tie the sheet around Citation: Atodaria PR, Atodaria KP, Patel VD, Vani N, Jain VR, et al. (2021) Customized Facial Protection Shield during COVID-19 Pandemic to Protect Surgeons Wearing Surgical Loupes While Performing Surgical Procedures. Archiv Surg S Educ 3: 024.

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the surgeon’s forehead (Figure 1) and micropore tape is applied (Figure 2). Two pieces of sponge are fixed with the OHP sheet at the upper edge keeping 3 cm distance on each side of midline of OHP sheet (Figure 3). Another longer sponge is put over the first pair of sponge and fixed with OHP sheet with micropore (Figure 4). The arrangement of sponges will make it more comfortable, absorb the perspiration on the forehead and also keep sufficiently sized gap for free air circulation and prevention of fogging. The face shield is worn on normal spectacles and upper border of the frame is marked (Figure 5). Upper border of the loupe spectacles is aligned with the marking and the upper part of both optic cylinders are marked (Figure 6). To accommodate the loupes optic system, two “X-shaped” markings were made at appropriate measured points on the sheet (Figure 7). These “X shaped markings were incised so as to create an aperture with four triangular flaps which can easily accommodate the loupe optic system Figure 3: Fixation of two sponges. to pass through it (Figure 8). Multilayered micropore tape was used to seal the minute gap created after passing the loupes through the sheet. We have used the above-mentioned indigenous face shield in 27 surgeries now. We have found it to be very comfortable, easy to wear, safe, very light weight, cost effective, completely accommodating the loupe magnification optic system and completely prevented fogging (Figures 9 and 10).

Figure 4: Fixation of longer sponge.

Figure 1: Creation of four apertures at upper border in OHP [Over Head Projector] sheet.

Figure 5: Marking of upper border of spectacle frame.

Figure 2: Thick elastic thread passed through apertures and tape applied. Figure 6: Marking of upper part of optic cylinders of loupe.

Volume 3 • Issue 2 • 100024 Archiv Surg S Educ ISSN: 2689-3126, Open Access Journal DOI: 10.24966/ASSE-3126/100024 Citation: Atodaria PR, Atodaria KP, Patel VD, Vani N, Jain VR, et al. (2021) Customized Facial Protection Shield during COVID-19 Pandemic to Protect Surgeons Wearing Surgical Loupes While Performing Surgical Procedures. Archiv Surg S Educ 3: 024.

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Figure 7: Marking and incision of the X shaped points.

Figure 10: Lateral views of customized face shield for accommodating magnifying loupe optic system.

Conclusion As per the authors, it may not be the ideal solution, but in exceptional times such as the COVID-19 pandemic, when the resources are scarce and the emergency medical procedures need to be constantly performed, innovative solutions such as the customized face shield can help maintain the safety of the healthcare workers while giving the surgeons the flexibility to use magnification loupe systems for all emergency surgeries. The authors suggest the utility of the customized face shield for elective surgical procedures like hair Figure 8: Loupe optic cylinders passed through aperture. transplantation in time to come as the COVID-19 pandemic may last for a long time. References 1. Huang C, Wang Y, Li X, Ren L, Zhao J, et al. (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet 395: 497-506. 2. Li Q, Guan X, Wu P, Wang X, Zhou L, et al. (2020) Early transmission dynamics in Wuhan, China, of novel coronavirus–infected pneumonia. N Engl J Med 382: 1199-1120. 3. Liu Z, Zhang Y, Wang X, Zhang D, Diao D, et al. (2020) Recommendations for surgery during the novel Coronavirus (COVID-19) epidemic. Indian J Surg 11: 1-5. 4. Forrester JD, Nassar AK, Maggio PM, Hawn MT (2020) Precautions for operating room team members during the COVID-19 pandemic. J Am Coll Surg 230: 1098-1101. 5. Mungadi IA (2010) Refinement on surgical technique: Role of magnification. J Surg Tech Case Rep 2: 1-2. 6. Bhattacharya S (2012) Congenital anterior urethrocutaneous fistula. Indian J Plast Surg 45: 566-567.

7. Huh S (2020) How to train the health personnel for protecting themselves from novel Coronavirus (COVID-19) infection during their patient or suspected case care. J Educ Eval Health Prof 17: 10.

Figure 9: Front view of customized face shield for accommodating magnifying loupe Video Link: https://youtu.be/LvE4pPPzl8Q optic system.

Volume 3 • Issue 2 • 100024 Archiv Surg S Educ ISSN: 2689-3126, Open Access Journal DOI: 10.24966/ASSE-3126/100024

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