what difficulties await during treatment

Even 2 years ago, we could not imagine that we would see so many people with prosthetic limbs on the streets, in coffee shops, everywhere. The full-scale invasion led to a rapid increase in amputations, and as a result, the market for prosthetics exploded.

Since 2015, after the start of the Russian-Ukrainian war, the state has guaranteed financing of prosthetics for its citizens. An abnormally high number of injuries from the beginning of 2022 only temporarily stressed the prosthetics industry, but quite quickly the enterprises adjusted their work in new conditions, even began to develop dynamically, to master the production of more technological, high-quality products.

There are many public veteran organizations and foundations working in the country, and the state social policy promotes adaptation to the normal life of a person with limb loss. It caused changing the culture of perception of a person with a prosthesis in societybecause the soldiers, wasting no time, put on prostheses, train and, inspired by the example of other soldiers with prostheses, return to social life.

It is a completely different situation when a soldier is injured in the head and face and interacts with the state at the stage of treatment and rehabilitation.

If the patient is not provided with proper help, then such soldiers usually try not to interact with society, sit at home, depend on the care of their relatives and are deprived of the joys of a normal full life.

Their faces look distorted because of the damage, with damage to the jaw, the ability to speak, chew and eat properly is lost, which leads to further health complications.

Almost every facial injury results in extensive tooth loss, which also deprives a person of a full life. It is impossible to eat normally, smile, kiss. What quality continuation of life can we talk about when a young person is not capable of basic things?

A significant part of facial injuries leads to the loss of one eye and mainly the quality of vision in the other. More and more often we are faced with cases of complete loss of vision due to injuries. The ability to smell is lost, sometimes permanently.

All these are the consequences that military personnel have to face after head and face injuries. And when such patients also have injuries to other parts of the body, amputations, the task of recovering for rehabilitation becomes extremely difficult. It is one thing when the face is intact and the soldier has the opportunity to eat well, gain weight lost after operations, and train at full strength. And imagine how a person can restore physical strength and do strength exercises, if he is deprived of the opportunity to eat a balanced and high-quality diet, to gain vital energy.

Unfortunately, I have to state that in the field of treatment and rehabilitation of facial injuries in Ukraine, there is still not enough attention, therefore most of these soldiers do not receive adequate assistanceand return to their cities, villages, district centers, where they continue life within 4 walls.

In December 2023 on the academic research platform Oxford University Press (OUP) in the “Military Medicine” section, the research data were made public “Maxillofacial surgery in Ukraine during the war: challenges and prospects”conducted by a team of leading experts in this field.

Combat injuries to the face are quite common, because this part of the body is exposed in the conditions of a collision. According to research data, among all wounded combatants in Ukraine, 18-25% have facial injuries. Up to 2/3 of these wounds require specialized, highly qualified surgical care.

There are several aspects that have influenced the state of affairs with state support (i.e. the lack thereof) of the military in the field of maxillofacial surgery (HCLH).

• Until 2022, the field of innovation in the field of SCI developed in an evolutionary way and did not encounter mass cases of combat injuries. Approximately since 2018, the technology began to be used in medicine replacement of lost bone fragments of the facial skeleton with medical titanium implants printed on a 3D printer and other materials. This method has proven its effectiveness in cases where bone loss occurred during oncology treatment.

• Until 2022, the number of combat facial injuries with bone destruction in Ukraine was not so massive, the military received help in military hospitals, and in difficult cases, foreign colleagues came to help. They operated the military as as part of foreign missions, as well as in the hospitals of their countries. Interventions were often carried out by multidisciplinary and multinational teams gave Ukrainian specialists the opportunity to gain new experience and to enrich knowledge about the peculiarities of reconstruction of combat injuries of the face.

• Until 2021, the most professional category: maxillofacial surgeon was not even introduced in the national register in Ukraine. In fact, this specialization appeared in the registry a year before the full-scale invasion. At that time the register was not completely filled, which makes it impossible to even estimate today how many maxillofacial surgery specialists work in Ukraine? Pre-war estimates indicated about 250 doctors, but after the occupation of part of the territory and after a full-scale invasion, the departure of some specialists abroad, etc., it is about a little more than 100 doctors, but there is no exact data.

• With the beginning of a full-scale invasion and the rapid increase in the number of wounded with facial injuries, the inability of military hospitals to provide care for an abnormally large number of soldiers, patient flows began to be diverted to civilian hospitals. Khsurgeons experienced in the use of individualized 3D implants began to use this bioengineering technology to compensate for bone fragmentslost as a result of mine-explosive and bullet wounds.

• In the first months of the full-scale invasion, when the flow of humanitarian aid to Ukrainian hospitals was frantic, surgeons had the necessary medical supplies and performed such operations on anyone who needed it. Ukrainian manufacturers of individualized 3D medical products were also able to manufacture and deliver implants for free for the first time. Successful cases were developed, which Ukrainian surgeons began to present at medical and scientific platforms, including to colleagues from other countries. It was like a medical revolution. Our experience has become the subject of discussion among military surgeons around the world, leading Western specialists are honored to operate with our doctors.

• Unfortunately, resources are running out. And the number of wounded does not decrease. Plates, customized implants, other specific materials must be purchased. Unfortunately, the state does not provide financial coverage to hospitals for such costs. What to say? The “Head and Neck Surgery” package has not yet been approved by the National Health Service of Ukraine (NSHU), which should include the costs of services related to maxillofacial surgery. Because of this, doctors are forced to actually work as volunteers, because they perform real operations lasting many hours, and the state does not seem to see them. At this stage, a year ago, the team of the Eastern Star Charitable Foundation and I created the DOCTORS FOR HEROES project to look for opportunities to support soldiers during treatment in wards. Without the help of benefactors, doctors would not have the opportunity to fully help the military, because consumables are very expensive. The average cost of an individualized implant is about 100,000 hryvnias.

• Exoprosthetics is a separate area of ​​work with facial trauma that is not covered. Unfortunately, Ukraine was not ready to provide patients with eye prostheses, exoprostheses for ears, and nose. The industry is underdeveloped due to a lack of specialists. Our partners are actively looking for specialists in the manufacture of silicone and other products to improve the aesthetics of injured faces in cases where plastic surgery is ineffective, or when a person has to wait a long time for the restoration of the organ. But even those capacities that are available are once again hampered by the lack of funding from the state. Although, what difference does it make, which prosthesis is needed by a soldier who lost an organ in the war? If there is free prosthetics of arms and legs, the cost of installing eye prostheses and other body parts (exoprostheses) should also be covered.

I really hope for a reaction Ministry of Social Policy and the creation of appropriate legislative initiatives in this area.

Ukraine has sufficient potential to provide quality treatment for its defenders with facial injuries. We have highly professional maxillofacial surgeons, ophthalmologists, otolaryngologists and other specialists who know how to work as a team, consistently and efficiently.

It was they, in collaboration with Ukrainian bioengineers, who achieved revolutionary changes in approaches to the treatment of maxillofacial injuries. It remains to ensure these assets and advantages with systematic state support.

We invite the Ministry of Health of Ukraine, the Ministry of Veterans Affairs, the Ministry of Defense of Ukraine, the National Health Service of Ukraine, public organizations and foundations working in the interests of veterans and military personnel to dialogue and fruitful cooperation.

Natalya Lyutikova, the founder of the charitable foundation “PHYSICIANS FOR HEROES”, especially for UP. Life

Publications in the “View” section are not editorial articles and reflect exclusively the author’s point of view.