Not only aesthetics. How scars and scars interfere with life and how they are treated in Ukraine

War leaves many scars and burns on the bodies of military personnel and civilians. Explosions, mines, direct hits from missiles and fires lead to the fact that the skin of the victims is covered with scar tissue or “applies” a traumatic tattoo. These consequences of injuries create not only psychological discomfort, but also interfere with free movement.

However, special protocols for working with scars and scars caused by military operations are being developed in Ukraine. The Neopalimi project, which treats military and civilian victims of war, is a pioneer.

“UP.Zhyttia” asked project manager Maksym Turkevich and chief physician Oleksandr Turkevich why it is important to remove scars from the body and why fresh scars cannot be treated.

How scars and scars are formed

Scars and scars are formed as a result of the natural process of wound healing. The body begins to restore damaged tissues and “builds” a layer on top of the injured area.

Often the cause of scars and scars are thermal and chemical burns, injuries and surgical interventions.

Scars are divided into three broad categories: hypertrophic (structural changes in the outer layer of human skin after healing of a wound or burn), atrophic (deep scars affecting the deeper layers of the skin) and combined.

Doctors note that scars and burns are not only an aesthetic problem, but also a functional one, which directly affects the quality of life of patients.

“Scars should not adorn anyone. We do not live in Viking times, when scars all over the face were the mark of a warrior“, says doctor Oleksandr Turkevich.

He adds that the patient’s quality of life is also influenced by where this scar is located (near the joints and whether it prevents them from moving), what its area is, and the ability of the body to recover.

For example, a scar on the back may seem unimportant. However, it can itch and begin to tighten the skin, change posture, etc.

This was the case with the patient Viktoria from Vinnytsia, who was injured in the Officers’ House. The woman was a military personnel and was supposed to retire on February 24, 2022. But due to a full-scale invasion, she continued her service.

“In July 2022, the Russians targeted the “Officers’ House” in Vinnytsia, where Victoria served. When the rocket landed and the fire started, the uniform on the woman’s back caught fire. She tried to put it out, but nothing worked“, says the doctor.

Victoria had a large area of ​​burn on her back, which was very itchy after healing. She noted that sometimes she combed her skin until it bled.

Scars on Victoria’s back in the process of treatment

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Injuries to the extremities (hands, elbows, shoulders, feet, knees) and face (mouth and jaw joint area) can limit movement. This phenomenon is called contracture and can even lead to disability.

For example, in the first patient of “Neopalymykh” Artem Melnyk there were many different injuries, among them a burn on both hands. He was injured as a result of a flight to the “Retroville” shopping center in March 2022 in Kyiv.

“Artem’s hands were badly burned. In his case, our goal was first to restore hand function. When he came to us, his hands did not bend due to scars.

The scars were hard, blocking the movement of muscles and bones. After three months of treatment, Artem was able to make a fist.” says the dermatologist.

How the patient’s hands changed after the procedure

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How is the treatment of scars

The scar removal procedure is not painful, but a little uncomfortable, the dermatologist notes. Scars are removed using a special laser.

“The laser literally burns the excess skin, and it will not be perceived as something pleasant. If the area of ​​scar tissue is significant, an anesthetic is used. After the procedure, swelling and inflammation are possible, it is necessary to lubricate the skin with creams and make masks, avoid direct sunlight“, Maksym Turkevich explains.

Scars also have sensitivity, which can be either increased or decreased. However, patients usually describe the treatment as a slight tingling sensation during certain stages of scar grinding.

Scars often restrict movement

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As Oleksandr Turkevich explained, the amount of excess tissue can be reduced in 2-4 procedures. This will help increase functionality from 10% to 80%. At the same time, the scar will become less bright, but will not disappear after several procedures.

Not all scars can be completely removed – it depends on the depth and area of ​​the lesion. But thanks to the treatment, the hands become less noticeable.

On average, treatment lasts 12-18 months. The patient comes to the clinic once every 1-1.5 months.

But it is impossible to treat “fresh” scars, the doctor notes. In an adult healthy person a scar is formed for 4-6 months.

Scars before and after treatment

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“It is worth counting not from the moment of injury, but from the final healing. Because for some, this process lasts 2 weeks, and for some – several months. Therefore, each case should be considered individually, because some really need more time“, Maksym Turkevich explains.

In working with scars in children has its own specificity. First of all, children have a much smaller body and a relatively larger area of ​​injury. Since the body is young, regeneration processes occur faster. Sometimes it’s a plus, and sometimes it’s a minus.

However, the biggest challenge is their ability to tolerate certain manipulations. Therefore, children under 14 years of age are taken for treatment only under sedation.

“You can come to an agreement with the teenager and explain that you need to be patient for 10 seconds. And holding by force can become a moral injury. Therefore, there is cooperation with a children’s hospital, where anesthesiologists, a resuscitation team, etc. work with small patients. We bring the equipment, and I carry out the manipulations.” says the dermatologist.

How is the process of treating children

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Traumatic tattoo and traces of torture

In addition to scars from explosions, injuries and burns, military and civilians are increasingly turning to specialists to remove traumatic tattoos.

This is powder, small fragments, dirt, which during explosions “eats” into the skin much deeper than ink in a tattoo. At the same time, it is not important to be directly at the place of the explosion. But the closer – the greater the risks.

“A patient came to me who has many health problems, including a traumatic tattoo. When he entered the elevator of a high-rise building, the children were scared of him, so he came to get rid of this problem in the first place.

Now it can be done in 3-4 procedures. The skin swells slightly during laser operation, so it is not possible to remove everything in one visit”– says Oleksandr Turkevich.

What does a traumatic tattoo on the face look like

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The second “specific” problem is the consequences of torture. In the spring of 2023, a photo of a freed soldier from Russian captivity circulated on social networks – the Russians carved a military swastika on his forehead. This injury was quite easy to remove from an aesthetic point of view, because the incisions were made along the frontal wrinkles. However, there are much more complicated examples.

“It does not matter whether it was torture or injury. The psyche of each of us is individual. And everyone has their own margin of safety.

But currently we have such a number of patients that you understand: it would be better if there were less“, the doctor concludes.

Who and where can get scar treatment at “Neopalymy”

According to the calculations of “Neopalymykh”, approximately one in four servicemen suffered an injury that caused a deformity or a burn.

But turning to specialists depends on how much the patient is worried about it. Usually, the military first solves more urgent and urgent problems (for example, making a prosthesis, restoring the mobility of a limb, etc.), and only then goes to specialists regarding scars or hearing lossfor example.

Unfortunately, there are no state programs in Ukraine yet, but there are volunteer projects. For example, about 70 patients with various injuries are currently being treated at “Neopalymy” and another 100 are waiting. These are military, civilians, volunteers, children.

For example, Natalia from Mariupol applied to the center. She was injured as a result of the explosion of an aerial bomb. At that moment, the woman was in the dormitory – standing by the window. The blast wave actually “shot” the glass in Natalia’s face.

The result of Natalia from Mariupol’s treatment

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“Natalya applied in August 2022 with a complex injury – cicatricial deformation of the face. The woman said that she dreams of taking her son to the first grade. So we had a hard deadline – we had to return her face to a certain aesthetic appearance within a year“, says Maksym Turkevich.

On September 1, 2023, Natalya did her makeup and took her son to school.

Oleksandr Turkevich adds that currently 32 clinics are operating throughout Ukraine in most regional centers within the framework of the project.

“We open a new center only when we see that the current ones are loaded. All project doctors are volunteers. For example, I set a goal that I would spend about 10% of my time on these patients, but currently it is about 30%“, he says.

Treatment takes place in a network of clinics throughout Ukraine

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The doctor notes that all project specialists have undergone specialized training and know the specifics of working with cicatricial deformities. After all, there are a lot of specific moments that are related to the circumstances of receiving an injury – mine-explosive, chemical burns, burning in a conventional tank or car, etc.

“Some approaches may work and some may not. Over the past 2 years, protocols have been developed that describe how to work with certain injuries. For example, there are now many patients with traumatic tattoos and several patients with traces of torture“, adds Oleksandr.

Plastic surgeons who conduct reconstructive operations if necessary.

Victoria Andreeva, UP. Life