Dr. Anthony Brissett examines a patient scheduled for surgery. He is joined by Dr. John Frodel (standing behind Dr. Brissett) and Dr. Raymond Cho (standing to the side of Dr. Brissett) and other members of the team.Face the Future Foundation
In an operating room in the western Ukrainian city of Ivano-Frankivsk, a Canadian plastic surgeon and his Ukrainian colleague work together to reconstruct the shattered nose of a soldier using skin from his forehead.
The sophisticated procedure, known as a forehead flap, takes four hours and is watched on a livestream by surgeons from around Ukraine, including some in the war-ravaged Donetsk region in eastern Ukraine.
“The injuries that we’re seeing here are the most horrific I’ve seen in all my years of mission work,” says Anthony Brissett, the Kitchener, Ont.-born doctor who leads the surgery. “I’ve been to Rwanda following the genocide and I’ve been to many other places around the world, and the intensity and significance of these injuries are magnitudes worse.”
Dr. Brissett is the mission director for a team of volunteers who travelled to Ukraine late last month to operate on 30 soldiers and civilians whose faces bear the scars of a Russian invasion that has dragged on for more than a year.
Many of their patients were victims of bomb blasts that tore away bone and soft facial tissue, sometimes shearing off ears or leaving patients blind. Most were stabilized by doctors near the front lines and sent back to regional hospitals such as the one in Ivano-Frankivsk, where Ukrainian surgeons trained in peacetime had to figure out how to repair war wounds they’d never encountered before.
“It’s very difficult for us,” says Nataliia Komashko, the head of the Ukrainian association of endoscopic head and neck surgery. “When we saw these patients the first day, we didn’t know what we could do for them.”
Dr. Raymond Cho, an Ocular Surgeon from Columbus, Ohio, sitting down at the head of the operating table surrounded by Face the Future Foundation and Ivano-Frankivsk surgical and medical teams.Face the Future Foundation
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Before the war, Dr. Komashko spent her days performing routine otolaryngology procedures such as removing tonsils and repairing deviated septa. Last Wednesday, she operated alongside Dr. Brissett as he surgically attached a section of forehead skin to what remained of the nose of a soldier whose face had been partially blown off, leaving him looking, as Dr. Brissett described it, a bit like the sphinx.
The patient will need another procedure to disconnect the skin of his new nose from his forehead in four to eight weeks, after Dr. Brissett has returned to his day job as professor and vice-chair in the Department of Otolaryngology/Head and Neck Surgery at Weill Cornell College of Medicine and Houston Methodist Hospital.
With his guidance, Dr. Komashko plans to perform that surgery on her own. Then she’ll teach the technique to her Ukrainian peers.
Training local doctors and nurses is a vital part of the mission of Face the Future Foundation, the humanitarian organization that led the recent trip to Ivano-Frankivsk, a city of nearly 250,000 and home to a 2,000-bed regional hospital. A New York-based group called Razom for Ukraine also backed the mission with money and logistical support.
“We like to work ourselves out of a job over five or 10 years, whatever it takes,” said Peter Adamson, the Canadian plastic surgeon and facial reconstruction expert who founded Face the Future 27 years ago. “It’s very much about teaching the man or woman to fish rather than just giving them fish.”
Patient Ruslan Andruhovish. Ruslan had a multi-segment fracture of the right frontal bone and orbit. He has no eye globe and is now blind and he sustained hearing loss from a blast.Face the Future Foundation
Dr. Adamson, a professor in the Department of Otolaryngology – Head and Neck Surgery at the University of Toronto, is one of six surgeons, including Dr. Brissett, who landed in the Polish city of Krakow on March 25 and travelled to Ivano-Frankivsk by bus. The all-volunteer medical team included specialists in ocular trauma and facial reanimation, as well as four nurses and an anesthesiologist.
All told, they did 96 hours of surgery across three operating rooms over four days, performing 112 procedures on 30 patients. Along with livestreaming those procedures, the team welcomed more than 100 Ukrainians surgeons in person for a one-day symposium in Ivano-Frankivsk. The volunteer nurses held a training session with about 70 nurses from the Ivano-Frankivsk Regional Central Hospital.
Before the trip, the Face the Future team spent months virtually reviewing the cases of about 100 soldiers and civilians who Dr. Komashko and her colleagues identified as good candidates for complex facial reconstruction surgery. The team triaged about half of those candidates in person.
One of the patients they selected was Maxym Kyrylov, a 25-year-old soldier injured on the third day of the war. He was riding in a military truck in the city of Korosten, northwest of Kyiv, when a bullet broke through the window, pierced his cheek and exited through his nose.
Last Friday, Mr. Kyrylov, who had already undergone five surgeries, received a bespoke, 3-D printed facial implant designed to restore some of the volume in his cheek and around his eye socket. Surgeons also tightened his lower eyelid and repaired a scar on his cheek.
The day before, as he prepared for his surgery, Mr. Kyrylov, said he wasn’t sure how he would feel once it was finished. But after all he’d been through, one thing was certain: Mr. Kyrylov was “definitely not afraid.”