UAMS Otolaryngology Team Trains Ukrainian Surgeon in Complex Facial Reconstruction Surgery
| A team from the University of Arkansas for Medical Sciences (UAMS) Department of Otolaryngology-Head and Neck Surgery recently hosted a Ukrainian surgeon and taught him how to do a complex facial reconstruction surgery.
Yuri Chepurnyi, M.D., a maxillofacial surgeon of nearly 20 years who is a professor at the National Medical University in Kiev, Ukraine, spent about a month at UAMS undergoing training under a team assembled by James Suen, M.D.
“It was a very full, a very intense program, and very useful,” Chepurnyi said.
Suen is a renowned head and neck surgeon who has been on three volunteer medical missions to Ukraine during the last two years as the country struggles to defend itself against a Russian invasion, and he is planning a fourth trip in May.
“There are thousands of soldiers, and some civilians, who have had their faces blown apart, and they do an excellent job on the front lines putting them partially together, but they need major reconstruction,” Suen said, explaining that patients often wait years for a properly trained surgeon to do the reconstructions.
“To repair the damage when someone’s face has actually been blown apart, you really have to take tissue from other parts of the body and also take the blood vessels and sew them to blood vessels in the neck, in order for the flaps to survive,” he explained. “There are very few surgeons in Ukraine that have this special surgical ability. In fact, I only know of one in Kiev — where they have thousands of doctors — who can do the surgery.”
James Suen, M.D., and Yuri Chepurnyi, M.D., during training in the Patrick W. Tank Anatomy Teaching Complex, using soft embalmed donors.
In cities throughout Ukraine, there are many soldiers with severe facial injuries, Suen said.
Seeing the immense need firsthand prompted Suen to start a program in Arkansas to train Ukrainian surgeons in the complicated techniques.
“There are only a couple of universities in America that have set up a program like this to train Ukrainian surgeons,” he said. “A university in Oklahoma was the first. They have trained two or three Ukrainian surgeons. Yale University is now trying to set up a program, and we just started this, and Dr. Chepurnyi is the first surgeon we’ve brought over.
“I picked Dr. Chepurnyi because I know him, I’ve operated with him, and I knew he would learn quickly,” Suen said. “He can then take back the technical knowledge to teach others and do the surgery on patients that need reconstruction.”
“I’m here to be trained in microsurgery, which is one of the most difficult and complicated types of surgery in the head and neck area,” Chepurnyi said March 12, as he prepared to return to Ukraine. “Why it is important is that it is the only, certainly the most effective, way to restore defects and deformities caused by trauma.”
Chepurnyi said he spent many hours in the operating room observing Mauricio Moreno, M.D., a professor of otolaryngology-head and neck surgery, and Jumin Sunde, M.D., an assistant professor, as they performed complex reconstructive surgeries.
He was also able to practice microscopic sewing techniques and learn how to harvest the flaps from other parts of the body — activities coordinated by the UAMS Anatomical Gift Program and the Division of Clinical Anatomy..
“That’s a crucial part — and he has learned very quickly,” Suen said.
“We are transplanting tissue from different parts of the body — commonly from extremities — to the head and neck area,” Moreno said. “That’s a sequence that involves preparing the grafting site, detaching bone and tissue from the extremity and bringing it to where it’s needed. At some point, this tissue is detached from your body, and that is why we call it free flap.”
Next, Moreno said, “we have to reconnect the bone with some metal plates and reconnect the blood vessels, put it back together under a microscope. The blood vessels are tiny — they’re about 2 millimeters in diameter, which is about as close to the thickness of a quarter — so, pretty small, very meticulous, very tedious work.”
Yuri Chepurnyi, M.D., in blue shirt stands with members of the UAMS Otolaryngology-Head and Neck Team that were part of his training in complex facial reconstruction surgery.
Suen said UAMS has expertise in free flap techniques, “and I feel like this is a way of helping Ukraine surgeons so that they would have the technology to reconstruct the faces of their injured soldiers and civilians.
“He will be able to return to Ukraine and do the surgeries and also teach other surgeons, which can be a major benefit for Ukraine,” Suen said.
Suen said the patients who need this surgery often are missing much of their jaws and need reconstruction so they can eat and talk. “They also often have lost one or both eyes, so several oculoplastic surgeons from the U.S. have been going with us and reconstructing their orbits and putting in artificial eyes. It has been a big team effort to treat these soldiers.”
Moreno said that while reviewing some of the cases that Chepurnyi will handle in the next few months, “one thing that caught my attention wasn’t just the extent of the injuries — I expected those — but the number of women and other civilians who were impacted by a rocket or an explosion.”
Suen said the volunteer doctors on his team bring instruments and sutures with them, but there is a Christian Medical Association based in Ukraine run by a wonderful 27-year-old physician who helps provides supplies. Suen said the association helps transport his team across the border and arranges for them to work in hospitals.
“The association director goes around Europe and the U.S. and gets companies to donate sutures, medical supplies, and the association has a huge warehouse in Ukraine where it is all stored,” he said. “They furnish the supplies for free to any hospital in the country that needs them.”
“Because of limitations, our government generally supplies only general things,” Chepurnyi said.
Suen said he sees the UAMS training program “as a way of UAMS helping Ukraine to be able to offer state-of-the-art medical care to its injured soldiers and civilians.”