Saving life and limb: the NHS super surgeons reconstructing the war wounded in Ukraine

As fighting intensifies, plastic surgeons James and Ahmed treat the victims of war in an emergency hospital in Western Ukraine.

NHS surgeons James Henderson and Ahmed Emam are part of an important surgical mission to deliver life and limb-saving reconstructive surgery in west Ukraine following a request for help from an under-strain hospital. The surgeons are treating the war wounded, and training local surgeons in reconstructive techniques having swapped their NHS clinics for the operating theatres of an emergency hospital.

In Ukraine, the war-torn health system has been under intense pressure with an estimated 1000 civilians injured daily in the conflict. As the flow of war wounded continues to rise, so do the numbers of people needing the expertise of the plastic surgeons. The hospital’s operating theatre, more used to treating everyday surgical procedures is now dealing with bullet,shrapnel wounds and landmine wounds, in addition to the increase in other injuries that occur during war.

Medical evacuation train
Patients arrive at the hospital from the casualty train, a fully equipped medical train which evacuates critically injured civilians from the embattled frontline regions to safer health facilities in the west. Paramedics meet the train at the local station and transport the injured to the hospital where they will be treated.

The journey is not easy says James “Patients are transported from the frontlines on casualty trains with old wounds contaminated with dirt, fragments and clothing, sometimes with no dressings”. This leads to infections which can spread along limbs, making reconstruction very challenging.

Treating the victims of war

In recent weeks, the surgeons have been treating a range of injuries from bullet wounds, cluster bombs and landmines. “We are treating patients of all ages, from 7 year olds to 70 year olds” says
James “Patients arrive in waves. The first day we had five cases, by day two we are seeing 10 cases a day”. The next train brough us 30 new patients.

In the corridors outside the theatre, the wards are full of recovering patients and many will have months of operations and rehabilitation to come. Patients like ‘Volo’, a 20 year old who stood on a landmine. He arrived at the hospital with a one-week old wound, badly infected. He was operated on by a team led by Ahmed and James, who used the case to teach local surgeons microsurgical
reconstruction techniques. After 3 weeks on the ward Volo is ready to be discharged. In gratitude for the treatment he received, he has bought a specially made cake for the staff who treated him.
“Without this operation, he would have required amputation before a wound infection caused a threat to his life. ” explains Ahmed.

In Ukraine, supplies are scarce and the environment challenging

North Bristol surgeon, James says “Resources are scarce, there are not enough operating theatres and staff to treat the wounds as quickly as needed.

Without the basic plastic surgery equipment, the work is incredibly challenging. “The equipment here is about Second World War era and we’re having to sometimes use the kind of
techniques and dressings used in those times” explains James. Lack of supplies is also a major issue for the hospital and surgeons. “There’s a huge supply shortage in terms of dressings, theatre
disposable items like sutures and lack of surgical instruments” explains Ahmed. “We’re a war time speciality”

Delivering pioneering treatments in the most challenging circumstances, the plastic surgeons are reconstructing the war wounded using ‘Ortho-plastic’ techniques born of the battlefields of WW1.
James explains “We’re a war time speciality, many of our techniques were developed for injured soldiers and airmen during the great wars”.

Life before limb, was the guiding principle of surgery before the development of Ortho-plastics. The elite surgeons promote saving limbs and avoid limb amputation where possible. Working alongside
Ukraine colleagues they are training and upskilling surgeons in Ortho-plastic techniques.

The road ahead

As we move into the sixth month of the war, the strain on the health system will only increase. Outside the hospital, the weather is changing and a reminder of the stark winter ahead. How do the surgeons feel about the challenges ahead? “This is my passion -to help with trauma surgery” says Ahmed. “We will do as much as we can” adds James, “but there is a massive need for
more resources in Ukraine”.

Mr Henderson was nominated by his colleagues and patients for the Rising Star Award as one of the leading clinicians in Bristol. He was also a finalist for the Health & Care Awards 2017 for Best Clinician.

Mr Henderson was shortlisted for bristol and bath healthcare awards for work at NBT with the prison service. He won it in 2016 and was shortlisted 2017, 2018, 2019

Bristol post healthcare award being presented by TVs Dr Phil Hammond

Mr Henderson represented the British Association of Plastic, Reconstructive and Aesthetic Surgeons at the Houses of Parliament for the launch of national guidelines.

RCGP national award

Taking assembly at a local primary school

Teaching prison doctors