Relief in Ukraine: How plastic surgeons are serving the injured in a war-torn nation

Russian President Vladimir Putin on Feb. 24 launched a full-scale invasion of the sovereign nation of Ukraine that has killed and injured hundreds while displacing millions of citizens. News of the rapidly escalating crisis spread throughout the world, sparking both a global interest in Ukraine and worldwide outrage toward the Russian government.

Nevertheless, many may not be aware of what Ukraine and its people were like outside of the ongoing conflict with Russia. Furthermore, despite the role of media in strengthening humanitarian efforts during the current war, comparably less light has been shed on the existing partnerships forged between Ukraine and its partners in the West prior to this year.

In this article, we will showcase interviews with three academic plastic surgeons who have worked with anesthesia colleagues to deliver and develop sustainable medical care with physicians in Ukraine.

Daniel N. Driscoll, MD, serves as assistant professor of surgery at Harvard Medical School. Since 1999, he has specialized in the care and reconstruction of children with burn injuries or congenital conditions at Shriners Children's, Boston. Dr. Driscoll has participated in several mission trips with a focus in burn care in Ukraine, Colombia and Dominican Republic.

David L. Brown, MD, is the William C. Grabb, MD, Collegiate Professor of Plastic Surgery at the Department of Surgery of the University of Michigan. His practice includes a focus on complex wound reconstruction, reconstructive neurovascular surgery and oncoplastic surgery. Dr. Brown has conducted extensive research on tissue engineering and medical education, and he has also organized and participated in multiple mission trips in Ukraine over the past several years to treat pediatric and adult burn victims.

Brian P. Kelley, MD, practices in Austin, Texas, in affiliation with University of Texas at Austin and Dell Children's Medical Group. His interests include wound care and burn reconstruction. He participated in the mission in Ukraine as a resident at University of Michigan and does so now as an attending.

PSR: What sparked your long-term partnership with Ukrainian surgeons and physicians?

Dr. Driscoll: Our first collaboration occurred in 2004, around the time the Orange Revolution happened. The president, who was very westward leaning, used the presidential plane to

fly a severely burned child – more than 60 percent of her body and complicated by sepsis – to Shriner's. We were able to save her and watch her grow up. My colleague, Der Fuzaylov, MD, who's a pediatric anesthesiologist originally from Uzbekistan (fluent in Russian), made friends with burn doctors in Ukraine. Through that collaboration, we had dozens of other children come to Shriner's for acute and reconstructive care. He then asked me to come with him to Ukraine. We saw various burn units and started identifying areas to improve.

Many plastic surgeons like to do mission work. For some, it is just a one-time thing, but others get more involved, find their spot and return on a regular basis. We used to go every year. Last time we were in Dnipro, not too far from the current front line. I have heard that the airport and a few other facilities in the area were bombed.

Dr. Brown: Each year, one of our senior residents and I travel with a group of physicians from University of Michigan, Harvard, Shriners' Hospital and Washington University to various locations in Ukraine to provide pediatric burn reconstruction surgery to children who have no access to such care. We were in Dnipro for 10 days last September – you may have seen it in the news, as the children's hospital that was attacked. It's so sad.

PSR: What kind of cases did you perform in Ukraine?

Dr. Driscoll: We really concentrated on pediatric burn reconstruction, scar releases and revisions. In order to prevent any serious complications, we focused our efforts on procedures such as skin grafts, Z-plasty, keloid excisions or tissue expander placement. We avoided complex operations, such as reconstruction with free flaps. If a more complex approach was necessary, we would evaluate the kid in Ukraine and then arrange travel to the United States in order to provide care at Shriner's.

Dr. Kelley: Residents were involved in all cases. We used to take three residents per year, one typically chosen by each participating surgical attending.

PSR: Are there any particular cases that stuck with you?

Dr. Driscoll: I vividly recall a particular child with severe burn injuries (more than 70 percent of his total body) for whom Dr. Fuzaylov arranged a flight to the United States. He remained hospitalized in the ICU of Shriner's for about five months, followed by extensive rehab. We saw him for follow-up in Boston and Ukraine quite a bit and then I remember him showing me a video of him dancing "Gangnam Style" – the whole dance, the whole thing, he had every move down. To see this kid who had 70 percent TBSA burn show that he can really dance – that was really uplifting to see.

PSR: How have you funded these efforts to Ukraine?

Dr. Driscoll: Rotary International, Women's Ukrainian Relief Fund, Childrens Burn Foundation and other similar charities would help fund the trips and transport of children to Boston through MedFlight. Some children remain in Boston long-term for sustained care and observation. These endeavors were led by Dr. Fuzaylov of MGH and founder of Doctors Collaborating to Help Children (DCTHC.org). This charity funds many of the mission trips, as well as providing ongoing supply, education and burn prevention.

PSR: What barriers did you face during your mission trips?

Dr. Driscoll: Despite great preparation, the O.R. is not organized the same way as it is in the United States, and occasionally equipment was not functioning perfectly. Language barriers are also present, but we had translators available and we did learn a few Ukrainian words to communicate better with the staff in the O.R., such as ножиці (nozhytsi), which means "scissors."

PSR: What are the most pressing medical needs you saw in Ukraine?

Dr. Driscoll: In Lviv, in particular, we realized the doctors were quite talented but lacking in resources and educational tools. Through establishing DCTHC.org, Dr Fuzaylov and I are working to fill these gaps. We also set up a telemedicine unit and provide lectures and symposia to help train and work with Ukrainian surgeons and anesthesiologists. Before the war, we were able to transport patients to Boston for special services they could not receive in their hometown, such as radiation therapy for severe keloid scarring or complex microsurgical reconstruction. We were also able to introduce CO2 lasers for scar treatment. Since the war began, several patients have been transferred to the United States. This requires a lot of coordination – in many cases, patients and doctors reach out on social media.

Unrelated to the mission trip work, we are working on creating a textbook on simple procedures, such as skin graft application, with information on how to perform, indications and post-operative care to distribute to Ukrainian surgeons. Especially in times of war, many Ukraine physicians might need to perform procedures that are out of the scope of their specialty, so they need an easy guide. However, Ukrainian people will be mostly in need of medical care, primary care physicians and supplies such as antibiotics, sterile dressings, local anesthetics, etc.

Dr. Kelley: The greatest needs will come as the conflict dies down. Certainly, acute traumatic reconstruction is ongoing in any battlefield. However, our most critical involvement will be in the stages of secondary reconstruction. In Ukraine, even under normal circumstances, the acute care is dissimilar to the United States. Hospital stays are prolonged, the families care for many of the acute nursing needs of the patients, and surgical options are more limited.

They have the ability to save life and limb, but the resources for such things are definitely stretched thin. Almost certainly, these options are being considered sparingly now, given the economic and social costs of the war. However, in the coming years, secondary reconstruction will be paramount to returning the injured to work and function.

PSR: How has your work in Ukraine been affected by the war with Russia?

Dr. Brown: We've been hard at work since the crisis started. We've been successful in transporting significant amounts of urgently needed medical supplies directly to the physicians and hospitals that we've worked with in the past.

In addition, we've been able to transport three children, so far, to the United States for their care. With my close connection to the people there, I have found them to be incredibly kind, generous and caring. As a people, they're proud of their freedom and are wanting to make the most of their lives following their separation from the USSR.

PSR: How can medical professionals help doctors at the front lines in Ukraine?

Dr. Brown: The recent atrocities have been difficult to watch. I've been busy looking for donations of supplies and recently teamed-up with World Medical Relief and Omnis Foundation to ship a cargo plane filled with supplies from here – and from Boston, with the help of our trip leader, Dr. Fuzaylov – straight to the physicians treating the wounded there. We recently spoke to news media, attempting to garner additional support from Michigan hospitals and other donors. I'm also trying to get an area hospital to sponsor treatment of a war-injured patient – our group has brought three to the United States so far to other locations. Other physicians can follow our lead in their own, similar way.

Dr. Kelley: We've organized supply transport through the Ukrainian Ministry of Health. Most big medical centers have redirected their own donations through other entities, so many of those efforts have not been successful. However, any excess supplies would certainly be useful.

PSR: How can non-medical professionals assist?

Dr. Brown: We have a non-profit organization that's set up to support our work: dctohc.org. People interested in helping can make a tax-deductible donation on the site. Every dollar will be sent directly to helping with care of injured children in Ukraine. We don't have any overhead to cover.

PSR: What's the future of the surgical trips to Ukraine?

Dr. Driscoll: At this point, I'm not sure. They may not happen again because of the war. We've considered organizing mission trips to neighboring Poland and have kids travel there for surgery or follow-up.

When great people meet, miracles can happen and the successful mission trips in Ukraine are a great example. U.S. plastic surgeons driven by their passion established a sustained collaboration between Ukraine and the United States, and provided care to multiple children victims of burn injuries. The recent war with Russia might change the needs and the structure of this partnership, but hopefully it will not break the bridge between them.

Dr. Seu is a fourth-year medical student at Loyola University Chicago Stritch School of Medicine; Dr. Siotos is PGY-4 at Rush University Medical Center Division of Plastic Surgery and a PSR resident editor.