For the facial and reconstructive plastic surgeon, Brojoj Abraham, MD, FACS, lead a medical mission to an active war zone is not a new experience, but it is one that remains deeply demanding personal and professional. This May, Abraham and a team of American Academy of Facial and Reconstructive Plastic Surgery (AAFPRS) face surgeons and support personnel completed their fourth humanitarian mission to Ukraine, working together with local doctors in Lviv to perform an advanced facial reconstruction in injured civilians in the ongoing conflict. Beyond immediate surgeries, the objective of the team was the long -term impact: to train Ukrainian surgeons in complex techniques such as microvascular free flaps and implants captomized in 3D. In this interview with Practice of Plastic SurgeryAbraham, missionary travel leader and main advisor to the Face Committee, reflects on the logistics obstacles of the mission, the growing capabilities of local surgeons and how experiences in the first line of humanitarian care are remodeling their work in practice.
Practice of plastic surgery: Dr. Abraham, this was his fourth humanitarian mission to Ukraine with the AAFPRS Foundation. What were the most important medical or logistics challenges faced by your team this time?
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PSP: Many of the procedures performed by his team involved a complex facial trauma and a microvascular reconstruction. Can you guide us through a particularly memorable case that exemplifies the type of injury you are seeing on the ground?
Abraham: All stories are heartbreaking, but the woman with the top of her head (a large skull defect that exposes her brain) moves partially because it validates our efforts to work and train surgeons in Ukraine.
Valentyna Vasylivna Chekhachova, 72, was injured on January 1, 2023, active hostilities in the city of Bakhmut, Donetsk region, Ukraine. While he was at home, the Russian armed forces and the affiliated military formations launched an artillery attack against the city. As a result of the bombing, he suffered a traumatic head injury. The case is a low investigation in the trial, and a forensic medical examination was designated to evaluate the scope and nature of their injuries, as well as its impact on their health and quality of life. His injury is part of the broader pattern or damage inflicted to civilians who last the current war in Ukraine, especially in frontline cities like Bakhmut.
He had an open -headed wound with an exhibition plate and a severe infection; We were able to remove the plaque, but we could not operate it immediately due to the infection in and -in. We started the treatment of infection and Dr. Hnat Heych, the main Ukrainian surgeon with which we worked with the duration of our last trip, could carry out the complex reconstruction with our orientation. This reflects the truly collaborative nature of our efforts on behalf of the Academy of Facial Plastic Surgery to provide attention to the devastating thesis of war injuries.
PSP: His team also focused largely on the training of local Ukrainian surgeons. How does surgical education address in a conflict zone and what progress has you seen in the course of thesis missions?
Abraham: Our Ukrainian colleagues are very talented and experienced surgeons. However, they have no experience with complex procedures necessary for the reconstruction of significant facial defects, including microvascular surgery (where different parts of the body can be transplanted to allow reconstruction, for example, using the fibulae bone from the leg to reconstruct The neck. Face creating a mirror image of the opposite side). We have progressed significantly. On our first trip, we made two microvascular fins; On our second trip, we made four microvascular fins; And on our third trip, we made eight. After we left, our Ukrainian colleagues made about 30 fins for themselves, truly exponential growth in their experience.
PSP: With surgeries that last up to 12 hours and involve advanced techniques such as personalized 3D implants, how is the selection of patients, prioritization and postoperative care in a limited environment such as LVIV?
Abraham: We operate in 25 patients, but since there are so many kurad patients of the war, this is just a fall in the cube. That is why our educational efforts to train our Ukrainian cocklesas are so critical: it is the difference between giving them a fish instead of teaching them how to fish.
PSP: From a technical state point, what innovations or tools were essential for the success of this mission and how they compare to what is commonly used in private practices based in the United States?
Abraham: The most sophisticated reconstruction level we make are microvascular free fins and the application of 3D technology to create specific personalized implants of the patient. We strive to provide the same level of care in Ukraine as here at home in the United States.
PSP: How has your experience in Ukraine influenced your own perspective as facial plastic surgeon in private practice? Have you changed how you see your role or the impact of your work?
Abraham: I feel incredible to be where I am today and have the practice I have at home in New York. As I have the experience to help take care of these patients with devastating war injuries, I think it is my duty to help. My colleagues who joined me feel the same. It is a deep and union experience.
PSP: Looking towards the future, what are the objectives for future missions face to face in Ucrine and how can other facial plastic surgeons, the specials of private practice, involve or contribute?
Abraham: We would like to collaborate continuously and provide education in Ukraine. Depending on security considerations, we are looking to organize an educational conference in Ukraine. There are multiple ways to get involved: joining our AAFPRS Face to Face team, participating in educational conferences with our Ukrainian colleagues (this can be done remotely through zoom), Ukrainian surgeons hosts in the United States to provide training (Dr. Mark Mims has established a great program in Oklahoma), or simply donate AAFRS Ukraine. PSP
To donate AAFPRS face to face for Ukraine, visit aafprs.org/donate. For more information about AAFPRS face to face, visit AAFPRS.org/ftf or communicate with Karen Sloat a [email protected].