Bioterrorism: preparing the plastic surgeon

Abstract

Introduction: Many medical disciplines, such as emergency medicine, trauma surgery, dermatology, psychiatry, family practice, and dentistry have documented attempts at assessing the level of bioterrorism preparedness in their communities. Currently, there is neither such an assessment nor an existing review of potential bioterrorism agents as they relate to plastic surgery. Therefore, the purpose of this article is to present plastic surgeons with a review of potential bioterrorism agents.

Methods: A review of the literature on bioterrorism agents and online resources of the Centers for Disease Control and Prevention was conducted. Category A agents were identified and specific attention was paid to the management issues that plastic surgeons might face in the event that these agents are used in an attack.

Results: Disease entities reviewed were smallpox, anthrax, plague, viral hemorrhagic fever, tularemia, and botulism. For each agent, we presented the microbiology, pathophysiology, clinical presentation, potential for weaponization, medical management, and surgical issues related to the plastic surgeon.

Conclusion: This article is the first attempt at addressing preparedness for bioterrorism in the plastic surgery community. Many other fields have already started a similar process. This article represents a first step in developing evidence-based consensus guidelines and recommendations for the management of biological terrorism for plastic surgeons.

Figure 1

Man with small pox displaying the characteristic maculopapular rash. Source: Public Health Images Library (PHIL) id# 12165.

Figure 2

Cutaneous anthrax. Source: Public Health Images Library (PHIL) id# 1934.

Figure 3

This patient presented with symptoms of plague that included gangrene of the right hand causing necrosis of the fingers. Source: Public Health Images Library (PHIL) id# 4137.

Figure 4

This Vermont muskrat trapper contracted tularemia, which manifested as cutaneous lesions on the dorsum of his right hand. Source: Public Health Images Library (PHIL) id# 6466. Dr. Roger A. Feldman.

Figure 5

Six-week-old infant with botulism, which is evident as a marked loss of muscle tone, especially in the region of the head and neck. Source: Public Health Images Library (PHIL) id# 1935.