Dear Sir,
The coronavirus disease 2019 (COVID-19) is a viral infection caused by SARS-CoV-2, which spread around the world from December 2019 by registering about 433 millions of cases with 5,94 millions deaths around the world.1 Despite advances in pharmacological treatments and the efficacy of the vaccine, the self-protection by the use of facemasks still remains the main way to prevent and control the spread of the infection and to reduce the transmission of the virus.
During this period, in Italy and in the majority of the other countries, the use of face mask was mandatory indoors and outdoors.
Imposing the world population to spend many hours of the day wearing the personal equipment. Therefore international authors have questioned the long-term effects of chronic use of the facemask: Cotrin et al. showed that the patients reported feel shortness of breath, feel discomfort in the ears due to the elastics, dermatitis/skin problems and esthetic issues.2 Moreover, the authors of this paper have already previously demonstrated in a preliminary study3 the correlation between the chronic use of face mask in patients who underwent to parotid surgery for benign neoplasia, with a preauricular approach, and the delay of surgical wounds healing. In fact, during the angiogenesis and maturation phases of the wounds healing, any trauma to the area of skin involved in surgery will cause the destruction of the small sprouting vessels of the dermis, resulting in a dehiscence.4
The aim of this study is to evaluate the correlation between delayed wounds healing and chronic face mask wearing and to verify if it is valid for other types of facial surgical wounds. In particular we evaluated if submaxillary gland surgery and mandibular condylar fractures surgery with an external cutaneous approach can be involved.
In the study, we enrolled 377 patients who were divided in three groups: Group 1) 248 patients treated for benign pathologies of parotid gland needing a superficial parotidectomy or extracapsular dissection of neoplasia; Group 2) 74 patients treated for benign pathologies of submaxillary gland needing a submaxillary sialoadenectomy (sialoadenitis or benign neoplasms); Group 3) 55 patients treated for condylar fractures with external cutaneous approach. For each group, the patients were further divided in two subgroups: A) patients treated before the pandemic (March 2018-March 2020); B) patients treated during the pandemic (March 2020-March 2022) and forced to wear the facemask.
The total obtained results of dehiscences in the different groups are shown in the Table 1 . In the Table 2 is reported the group of totally of patients, regardless of the type of surgery.
Table 1.
Surgical outcomes for parotid gland surgery, submaxillary gland surgery and condylar fractures surgery.
| Parotid gland | No dehiscences | Dehiscences | Total |
|---|---|---|---|
| A (No Covid 19) | 128 | 4 | 132 |
| B (Covid 19) | 99 | 17 | 116 |
| Total | 227 | 21 | 248 |
| SUBMAXILLARY GLAND | |||
| A (No Covid 19) | 41 | 2 | 43 |
| B (Covid 19) | 25 | 6 | 31 |
| Total | 66 | 8 | 74 |
| CONDYLAR FRACTURES | |||
| A (No Covid 19) | 34 | 2 | 36 |
| B (Covid 19) | 15 | 4 | 19 |
| Total | 49 | 6 | 55 |
Table 2.
Surgical outcomes of total patients.
| Group total | No dehiscences | Dehiscences | Total |
|---|---|---|---|
| A (No Covid 19) | 204 | 10 | 214 |
| B (Covid 19) | 138 | 25 | 163 |
| Total | 342 | 35 | 377 |
We conducted a statistical analysis of the data, using a chi-square test (Microsoft Excel 16.16.27 Version), comparing in each group1, 2, 3 and in the total patients, the dehiscences in the two subgroups (No Covid 19 and Covid 19). The obtained values of chi-square test were compared with the chi-square standard distribution tables.
We obtained that for the Group 1 the chi-square test value was 10.76; for the Group 2 the chi-square test value was 4.04; for the Group 3 the chi-square test value was 3.07; for the totally of patients the chi-square test value was 20.11. All the values resulted statistically significant and in particular the significance increases as the number of patients in the sample considered increases.
In conclusion we can say that our data confirm the correlation between chronic use of the face mask and delayed healing of facial surgical wounds. In particular, the possibility of dehiscence does not depend on the type of surgery or the position of the surgical wound on the face, but depends on the rubbing trauma caused by the face mask.
To reduce the risk of wound dehiscence we strongly recommend the use of PPE masks with loop clips or extenders which appear to reduce this peculiar complication.
Funding
None declared.
Ethical approval
N/A.
Declaration of Competing Interest
None declared.
Acknowledgments
None.
References
- 1.https://en.wikipedia.org/wiki/Template:COVID-19_pandemic_data
- 2.Cotrin P., Bahls A.C., da Silva D.O., et al. The use of facemasks during the COVID-19 pandemic by the Brazilian population. J Multidiscip Healthc. 2020;13:1169–1178. doi: 10.2147/JMDH.S281524. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Bonavolontà P., Troise S., Arena A., et al. The use of Personal Protective Equipment during the COVID-19 pandemic: the effects on surgical wounds healing after parotid gland surgery. J Plast Reconstruct Aesthet Surg. 2021;74(12):3443–3476. doi: 10.1016/j.bjps.2021.09.005. [DOI] [PMC free article] [PubMed] [Google Scholar]
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