The team members
The reconstructive team comprises plastic surgeons, anesthesiologists, nurses, physiotherapists, and support staff. Roster for dedicated teams comprising of different members of the team should be made on rotation as per the availability. Due to the prolonged nature of the surgeries in head and neck onco-reconstruction compared to the other surgical procedures, the risk of infection and cross infection is possibly more. The reconstructive scenario involves a multiteam approach, such as a team for flap harvest and team for vessel preparation, which leads to overcrowding of the operative room. Provisions should be made to reduce overcrowding. We must consider the safety of the health care workers as the prime concern. The following points need mention
  1. The team should undergo Training in the proper use of Personal protective equipment (PPE), Sequence of donning and doffing.
  2. Every health care worker to use the face shield, N95 mask while working to protect the splashing of body fluid to eyes, face13,14.
  3. The face shields for plastic surgeons should be deep enough to accommodate the loupes.
  4. Bone cutting, drills, and power tools- these cause more aerosol generation, these aerosols may be a source of infection- should be avoided or done with precaution.16,17,18 A adhesive transparent sheet may be used to cover the saw and drill to prevent splashing in different directions. The irrigation and cutting/drilling should alternate to avoid splashing and minimize aerosol generation.
  5. During aerosol generation procedures like mandibular excision, fibular osteotomies, and tracheostomies, etc. only the minimum number of team members are allowed in the operation theatre. The ancillary staff may be asked to remain out of the operation theatre and the remaining surgeons not directly involved in the procedure may stand as far as possible (since two teams are simultaneously working)
  6. The anastomosis may be under loupes using a deep face shield that accommodates the loupes or
  7. Anastomosis under the microscope – use of face shield is not possible as the focusing is difficult due to the increased distance between the operating surgeon’s eye and microscope eyepiece. Hence, the use of protective safety glasses may be very useful to cover the eyes.
  8. The tracheostomy is covered using adhesive plastic cover (to ensure avoidance of air blast in accidental disconnection of the tracheostomy tube).
  9. All the procedures are done by experienced surgeons to reduce the time of surgery and reduce the chances of flap failure, re-explorations, and any untoward incidents in times of limited resources and manpower.