Introduction. The invasion of Ukraine by Russian troops on February 24th, 2022, and
the beginning of the full-scale war had huge humanitarian consequences. The major
challenges facing the Ukrainian health care system included the disruption of medical
infrastructure and logistics, the termination of the supply of expendable materials,
significant migration and a dramatic increase in high-velocity blast and gunshot injuries
among combatants and civilians.
The aim of the present study was to analyze the challenges and solutions in patient
care faced by the Ukrainian system of maxillofacial surgery during the war in different
regions of the country.
Materials and Methods. A cross-sectional study was designed and implemented as an
online survey to collect national data concerning maxillofacial surgeons’ experiences
and professional activities. The study was initiated and supported by Bogomolets
National Medical University (Kyiv, Ukraine), the Ukrainian representative of AO CMF
(Arbeitsgemeinschaft für Osteosynthesefragen Craniomaxillofacial Surgery) and the
University of Helsinki (Finland).
The questionnaire was developed by specialists in maxillofacial surgery and
sociologists and contained 65 close-ended questions. Surgeons who had not worked in
this specialty in inpatient departments of hospitals since at least the beginning of the
full-scale war were excluded from the study. We received and analyzed 97 responses
that met the abovementioned criteria. The geography of respondents covered all the
regions and the main cities of Ukraine, expect for the occupied territories.
Results. After a year of warfare, the percentage of surgeons who treated patients with
blast and gunshot injuries increased from 43.4% to 86.6%. This percentage was higher
in military hospitals and in regions located in the vicinity of the front line. We found that,
during the war, 78.6% of respondents performed osteosynthesis in cases of high
velocity multifragmented facial bone fractures (in such cases, 58.3% of them strictly
followed AO CMF recommendations, while 41.7% performed the fixation based on
available hardware, existing technical possibilities and their own preferences). We
found that 70.2% of respondents had the opportunity to apply CAD/CAM technology
and patient specific implants (PSI) for the treatment of gunshot injuries, 38.1% reported
that their hospitals were able to perform microsurgical reconstructions for facial
defects, 79.4% of respondents reported that their departments received humanitarian
aid and support from volunteer organizations (either Ukrainian or international), which
significantly facilitated the treatment process.
Conclusions. According to this nationwide survey of Ukrainian maxillofacial surgeons
during a year of the full-scale war, 86.6% of respondents were involved in the
treatment of gunshot and ballistic injuries in civilians and combatants. The main
problems reported by the respondents were 1) a lack of experience and knowledge
related to the treatment of severe wounds, especially by secondary reconstruction, and
2) a deficit of resources (equipment, materials and medications) under conditions of
disrupted logistics and changes in the numbers and nosological distribution of patients.
There were the opportunity to transfer the patients to European clinics (29.9%), online
consultations (45.4%), collaboration with foreign surgeons who come to Ukraine as a
volunteers (32%) |
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