The COVID-19 facemask: Friend or foe?

Dear Sir,

Few would disagree that the global COVID-19 pandemic has been the “Great Disruptor.¹” All of us have had to postpone elective cases unless there would be a significant potential for future morbidity or mortality.² To slow the spread and minimize the impact, society recommendations are that all “providers should wear personal protective equipment, including a minimum of face masks and face shields for all patients.²” In spite of these guidelines, we must still be the innovators and the leaders typical for our specialty for maximizing risk/benefit solutions for those other problems that have not taken a vacation. This is exemplified by a “routine” case where cartilage exposure of the nasal tip and columella followed Moh's surgical excision of a sebaceous carcinoma. Coverage using a standard median forehead interpolation flap appeared totally perfused 2 days postoperative. However, a week later the patient arrived for suture removal now wearing his protective face mask (Figure 1 ). When unveiled, the distal half of the flap was non-viable (Figure 2 ), obeying Vasconez's Second Law: “All of the flap will survive except the part that you need.³” Adjustment of eyeglasses from the nasal bridge always is advised to prevent forehead flap pedicle compression,⁴ but today we must remember that a mask must also be adjusted to eliminate pressure on the inset flap itself or perhaps use a face shield as a substitute. Complications take no holiday; and in spite of the COVID-19 crisis, we must still be the problem solvers—it is indeed our responsibility!⁵.

Figure 1.

Snuggly fit ear loop facemask with nasal bridge fabric coinciding with the upper boundary of inset median forehead flap.

Figure 2.

With mask removed, dusky lower half of inset flap proved to be non-viable secondary to compression.

Declaration of competing interest

None.