Potential challenges
In the face of the current pandemic, the cancer surgeons are at times forced to delay excision but the balance between the harm of delaying the surgery and protection from infection is hard to assess in general9. Cancer is considered as a semi-emergency and delaying treatment is difficult both for the treating oncologist and the patients. The pandemic in India at present may be at best described as early and its number of new cases of COVID-19 would only increase in the coming days despite the present lockdown. Cancer patients are exposed to the dual risk of cancer and COVID infection. Although, the initial reports suggest grave outcomes in cancer patients10. The evidence is inadequate for any conclusion. The onco-reconstructions have moved a long way from simple defect cover to better quality approach with more functional and aesthetically pleasing reconstructions11. Considering the present setting, it may be correct to predict that, the quality and quantity of reconstructions may be compromised, for at least some time. Just to highlight the demands in India, Tata Memorial Centre, a premier cancer centre in Mumbai, alone handles yearly load of approximately 900 cancer reconstructions in the department of Plastic and Reconstructive Surgery of which more than 60% are free flaps.
The overall plan of an onco-reconstruction is dependent on the capacity of the setup, capability and skill level of the team, availability of equipment, adequate infrastructure, and the aesthetic and functional requirement of the patients. (Fig 1)