Page 30 - JSOM Spring 2026

the presentation, diagnosis, and treatment of the cases but lack Optimization of Surgical and Triage Protocols
discussion of complications or risks. More details are pre- Based on metric analyses of injury patterns, it was possible to
sented as supplemental material in Table S1. differentiate and refine surgical, triage, and evacuation princi-
ples at various levels of medical care. A standardized classifi-
The STROBE assessment of the reviewed studies indicates that cation system was proposed, correlating wound dimensions,
all studies clearly described their titles, abstracts, rationales, volume, and anatomical localization with the appropriate
objectives, study designs, participant criteria, data sources, medical response and surgical strategy. Upon arrival at medi-
41
statistical methods, and ethical considerations. Most studies cal facilities, patient categorization into surgical and therapeu-
provided detailed outcome data, key results, and appropriate tic cycles was crucial for optimizing resource allocation and
tables/figures, ensuring a comprehensive presentation of find- treatment efficiency. The presence of gunshot fractures often
ings. However, several limitations were observed, including a necessitated specialized referrals, with some cases requiring
lack of discussion of potential biases, the absence of sample transfer to civilian hospitals during mass casualty incidents.
size justification, and the failure to acknowledge study limita-
tions in many studies. More details are presented as supple- Most patients underwent primary debridement, followed by
mental material in Table S2. staged surgical interventions, including external fixation and
conversion to internal fixation; soft-tissue reconstruction
through flap techniques and VAC therapy; and amputee re-
Discussion
habilitation with progressive prosthetic fitting, weight-bearing
This systematic review analyzed 31 studies published between training, and reintegration programs. 19,23,24,38
2014 and 2024, comprising 19 structured observational studies
and 12 individual case reports, all focused on military-related Comparative Insights with Previous Military Conflicts
injuries sustained during the ongoing Russian-Ukrainian con- The treatment methodologies observed in the Ukrainian
flict. The majority of these studies were case reports and retro- conflict share notable similarities with those from Iraq and
spective analyses, primarily based in Ukrainian military medical Afghanistan, where staged surgical interventions and limb
facilities and frontline hospitals, with a few involving Ukrainian salvage techniques were widely practiced. However, advance-
patients treated abroad. The study population predominantly ments in wound management (including the expanded use of
comprised male military personnel aged 24 to 40, although ci- VAC therapy and 3D-printed implants for arthrodesis) reflect
vilian casualties have significantly increased in recent years. a progressive shift in combat casualty care. 25,29 Unlike previous
conflicts, where high amputation rates were largely due to lim-
The injuries observed were severe and complex, commonly ited reconstructive capabilities, contemporary techniques such
involving soft-tissue damage, fractures, amputations, and neu- as distraction osteogenesis and bone transport have signifi-
rological trauma, primarily caused by high-energy combat cantly improved functional recovery and limb preservation.
mechanisms, such as explosions, gunshots, and blast-related
trauma. Surgical management played a critical role in acute The Role of Telemedicine in Modern Combat Medicine
treatment, including amputations, fracture fixation, nerve re- Telemedicine represents a transformative innovation in ad-
pair, and soft-tissue reconstruction, with advanced reconstruc- dressing challenges faced by patients, medical administrators,
tive techniques such as 3D-printed implants increasingly being and frontline healthcare providers. Previous research suggests
used. Rehabilitation strategies, including pain management, that 74% of patients prefer virtual consultations over in- person
physiotherapy, and prosthetic adaptation, were essential for visits due to time and financial constraints. Telemedicine
42
recovery, with select cases exploring regenerative medicine ap- significantly reduces unnecessary hospital visits, facilitating
proaches. While many patients successfully regained mobility real-time consultations and expert guidance, particularly for
and reintegrated into daily life, long-term complications such patients in remote or combat zones. 43
as chronic pain and PTSD necessitated prolonged follow-up
and continued care. In the context of the Ukrainian Armed Forces, telemedicine
offers a viable alternative for multidisciplinary care, ensur-
The Need for Multidisciplinary Rehabilitation Programs ing timely consultations across different levels of medical
Given the growing number of disabled individuals resulting assistance. International partnerships with leading global med-
from prolonged warfare, Ukraine urgently requires the imple- ical institutions further enhance the quality of telemedicine-
mentation of multidisciplinary rehabilitation programs guided enabled specialist consultations, enabling real-time collabora-
by unified principles and coordinated strategies. Research in- tion on complex medical cases. 41,44,45
dicates that a comprehensive approach to the rehabilitation
of disabled war veterans should integrate medical, social, and A notable example is the collaboration between the Charité
psychological components, ensuring an individualized and ho- Clinic in Berlin and the Military Medical Clinical Center
listic treatment framework. 39,40 (MMCC) of Ukraine’s Southern Region, facilitated by the
Teladoc Health system. This initiative enabled multimodal
During the armed conflict, surgeons frequently encounter screening and preoperative planning, comprehensive indicator
severe soft-tissue defects caused by gunshot wounds, exacer- analysis and patient monitoring, and the integration of multi-
bated by the unpredictable and high-intensity nature of hos- disciplinary teams, including specialists in plastic surgery, trau-
tilities. Addressing such injuries demands a multidisciplinary matology, anesthesiology, and resuscitation.
approach, involving vascular, orthopedic, general, and tho-
racic surgeons. As a result, the deployment of specialized med- Such international telemedicine collaborations not only ele-
ical personnel and the optimization of triage and evacuation vate the standard of medical care but also streamline complex
strategies become critical considerations in improving early surgical planning and postoperative monitoring, ensuring con-
medical intervention. 41 tinuity of care in conflict-affected regions. 30

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