Reconstructing the faces of battered and bombed Ukrainian soldiers | DW News

Key Concepts

• Facial Reconstruction: Surgical procedures to restore form and function to the face after severe trauma.
• War Trauma: The physical and psychological injuries resulting from armed conflict.
• FPV Drones: First-Person View drones, increasingly used in the conflict, leading to a rise in amputation cases.
• Triage (Red, Green, Black Patients): A system for prioritizing medical care based on the severity of injuries and likelihood of survival.
• Unbroken Center: The largest medical and rehabilitation facility in Ukraine, specializing in complex war injuries.
• Mass Casualty Incidents: Events resulting in a large number of casualties, requiring rapid triage and resource allocation.

Ukrainian War Injuries: A Surge in Complex Trauma & Rapidly Developing Surgical Expertise

Introduction

The ongoing war in Ukraine has resulted in a staggering number of casualties, with estimates reaching 150,000 killed or missing and nearly 500,000 wounded. This has placed an immense strain on the Ukrainian medical system, forcing doctors to rapidly develop expertise in treating complex combat injuries, particularly those involving facial reconstruction. This report details the experiences of patients and medical professionals at the forefront of this effort, highlighting the challenges, innovations, and psychological toll of treating war-related trauma.

I. Patient Case: Artam’s Journey to Recovery

Artam, a 38-year-old veteran, sustained catastrophic injuries in 2023 while fighting in Kubansk, caused by a 120mm shell. His injuries included a severely fractured jaw (half torn off from ear to jawline), penetrating wounds to both eyes, shoulder, elbow, both legs, and a testicle. After two years and numerous surgeries, Artam is nearing the completion of his reconstructive journey.

His final surgery, performed by Dr. Natalyia Kumashko and her team from the “Face the Future” mission, focused on removing excess tissue from a previous operation that closed a large facial wound using bone grafted from his skull. This 7-hour procedure involved six surgeons and successfully restored Artam’s ability to breathe through his nose. Dr. Kumashko expresses high confidence in Artam’s continued recovery, stating, “For me, Artam, everything here is a nine out of 10. And we’ll add the tense point when we remove this piece and clean your nose. And Artam and I will only see each other at nice events, not in the operating room anymore.”

Despite the physical improvements, Artam struggles with reintegration into civilian life. He previously worked as a funeral director in Odessa but feels self-conscious about his appearance, noting, “Well, it was annoying because people walk by, look at you, and then they start to turn away.” He finds solace and understanding among other veterans, particularly those with similar facial injuries.

II. The Psychological Impact & Veteran Support Networks

The transcript emphasizes the significant psychological trauma experienced by Ukrainian veterans. Artam, like many others, experiences intrusive thoughts and flashbacks before sleep, recalling near-death experiences and moments of failure. He acknowledges the need for psychiatric support and antidepressants. However, Dr. Natalyia observes that veterans often prefer to confide in each other, creating informal support networks. She notes a positive shift in Artam’s psychological state, attributing it to the visible progress of his surgeries and the support of his family. “When Artam arrived in October, his psychological state was not very good because he was worried. But now he's in a completely different headspace. First of all, he sees that the operation has had an effect. He gets to be at home with his wife and child and he says, 'Yes, I feel completely different.'”

III. Evolving Injury Patterns & Surgical Adaptations

Dr. Hennadii Hnat, Head of Plastic and Reconstructive Surgery at the Unbroken Center in Lviv, details the dramatic changes in the nature of war injuries. Initially, the conflict involved primarily artillery shelling, resulting in large-scale tissue defects. However, the increased use of First-Person View (FPV) drones has led to a surge in amputation cases. Furthermore, the winter weather in eastern Ukraine is causing a rise in frostbite and subsequent amputations.

Dr. Hnat explains that the Unbroken Center, located near the Polish border, serves as the fourth line of evacuation, specializing in complex reconstructive surgeries of the face, neck, extremities, abdomen, and torso. He highlights the rapid learning curve for Ukrainian surgeons, benefiting from knowledge transfer from international experts.

IV. Triage & Ethical Dilemmas in Mass Casualty Events

Dr. Hnat describes the harrowing reality of mass casualty incidents, particularly during the initial stages of the war. He explains the use of triage – categorizing patients as “red” (highest priority), “green” (moderate priority), or “black” (lowest priority) – to allocate limited resources effectively. The “black” category represents patients who are still alive but deemed unlikely to survive, and diverting resources to them would compromise the chances of saving others. He acknowledges the immense emotional and ethical burden of making such difficult decisions, stating, “It’s very difficult decision when you need to make it to to to do that unfortunately.”

V. Ukrainian Medical System’s Resilience & Future Outlook

The interview with Dr. Hnat underscores the resilience and adaptability of the Ukrainian medical system. Despite facing overwhelming challenges, Ukrainian surgeons have rapidly developed expertise in complex reconstructive procedures, demonstrating a commitment to providing the best possible care for wounded soldiers and civilians. The ability to perform these surgeries independently is a significant achievement for the Ukrainian medical team. Artam’s successful recovery and return to Odessa symbolize the hope for a future where veterans can rebuild their lives. However, the ongoing conflict and evolving injury patterns continue to pose significant challenges.

Conclusion

The war in Ukraine has created an unprecedented demand for advanced trauma care and reconstructive surgery. Ukrainian medical professionals are responding with remarkable skill, dedication, and innovation. The stories of patients like Artam, coupled with the insights of doctors like Dr. Kumashko and Dr. Hnat, reveal the profound physical and psychological toll of war, as well as the unwavering commitment to healing and rebuilding lives. The rapid adaptation to changing injury patterns, the implementation of triage protocols, and the development of strong veteran support networks are crucial elements in navigating this ongoing crisis.