Facial Pressure Sores in COVID-19 Patients during Prone Positioning: A Case Series and Literature Review.

COVID-19 has been a source of several stays in intensive care units, increasing the number of prone positioning. In parallel, complications increased, such as facial ulcers. Herein, we present a literature review and a case series about facial pressure sores in COVID-19 patients during prone positioning. This study aimed to show that such facial pressure sores may require surgical intervention in specific cases. Methods: We performed a search of the literature with the Pubmed database, and we selected 13 articles for review. Therefore, we analyzed the results among the most frequent locations of facial ulcers: cheeks, ears, lips, nose, and chin. We also reported three original clinical scenarios with a gradual surgical approach to address facial pressure sores from less invasive to more invasive surgery (corresponding to the reconstructive ladder strategy) during the COVID-19 period. Results: We identified 13 articles related to the topic. Only four clinical cases discussed a surgical treatment but only for complications such as bleeding, infection, and sequelae after long-term management. Faced with a lack of literature about surgical options, we reported our case series showing that surgical treatments could be increasingly complex among the sore grades. The following surgical approach was selected: debridement, skin graft, and local or free flaps. Conclusions: Surgical intervention is the last course of treatment for pressure sores. However, the need for later surgical revision cannot be excluded, especially regarding the face, in case of dyschromia or retraction affecting the facial aesthetic subunits.