We treat bullet, shrapnel and blast injuries, from an acute wound to restoring tissue, form and function, including defects, fragments, scars and contractures.
The reception with both a fresh wound and a hospice, and if there are signs threatening lives, it's 103 first.
Before Arrival
If the wound has already been treated, take your medical records, descriptions of operations and pictures – the surgeon will evaluate what was done and make a plan for next steps.
103 or seek urgent medical care if:
Strangulation does not stop with bleeding.
The wound is blushing, and swells, and out of it is a pus or an unpleasant smell.
The temperature has risen, the heat has risen, and there is confusion;
And the limb became cold, pale, namil, and weakened.
The pain in the wound or limb increases sharply or prevents the movement of fingers;
Inhalation is frequent or difficult to breathe, skin is pale, blue, or spot almost no urine.
01 / WHAT IT IS
What is wound surgery.
Shot wound surgery repairs tissue, bone, blood vessels and nerves after bullet, splinter or mine injuries.
Reconstruction of gunshot and mine-exploded wounds in modern surgery is a multistage concept that has undergone fundamental changes over the past years, not least thanks to the experience of Ukrainian military and civilian medical professionals. A fire wound differs from an ordinary one: it has a zone of primary necrosis (destroyed tissue) and a secondary necrose (comas) - the tissue around the canal which at first appears alive but due to impact and temporary pulsating cavity some of them may die within days.
Patients consult a surgeon with a fresh wound, a wound that does not heal, a residual tissue or bone defect, retained fragments, or scars that cause pain or restrict movement.
The specific indications, method and expected result are determined individually by the doctor after consultation and necessary examinations.
02 / With PM, it's dead.
The consequences of the injuries we treat.
Six situations that are most common.
01
A fresh or non-healing wound
Fresh balloon or shard wounds; mocha wound for weeks; tendons or bone are visible.
How it is treated
The wound is cleaned of dead tissue – fresh one usually several times, under a vacuum bandage if necessary – and when it is clear, the wounds are covered with skin or flaps. If the injury persists due to infection of bone or fragments, first treat the cause.
The shrapnel or bullets were left in the body after the inspection.
How it is treated
Not every fragment needs to be removed. Removal is considered when a fragment causes pain or infection, lies within a joint or near a nerve, or raises the blood lead level. The decision is made after an examination and CT scan.
Scars pull on the skin, cause pain and restrict joint movement.
How it is treated
Scars are cured, the lack of skin is covered with local flaps (Z-plastic), graft or flap; surface leveled by laser. After surgery — tires and rehabilitation.
Fractures, bone and tissue defects, wreckage, facial damage. Facial reconstruction after injury is a distinct specialty that uses 3D planning, tissue flaps and facial reanimation.
Fracture wounds, scarring the head down or sideways. Scars are excised and closed with local flaps; fragments near blood vessels are removed only when clinically indicated.
The effects of the soft tissue of the chest, the abdomen, the back, the scars after the laparotes. Closure with tissue flaps, scar correction and lipofilling of depressed areas.
Major tissue and bone defects, wounds above the cyst, cookie after amputation. Microsurgical flaps, the induced-membrane technique and TMR before prosthetic fitting.
Modern reconstruction of such wounds relies on several surgical technologies — from initial treatment to late reconstructions.
The most common surgeries:
In most cases, drugs can be obtained — both fresh wounds and consequences.
Operation
When needed
Surgical treatment and healing
The wound does not chase, naked tendons or bone
Removal of external bodies
Fracture pain, disease, or joint
Cutting scarring, Z-plastics
The scar pulls off the skin and limits movement
Post-op stitches correction
Gross, deformed scarring after hospital surgery
Laser sanding of scarring
Flat surface of the scar, often with surgery
01
Early staged surgical debridement and negative-pressure wound therapy (NPWT)
The wound is being cleaned up again and actively leading to closure, not waiting for it to heal itself.
Tissue Saved Debridment
For more precise cleaning, a hydrosurgical system (for example Versajet) can be used: a thin jet of physiological solution layers down and sucks away dead tissue and contamination, which helps to preserve more living tissue.
Vacuum bandages (NPWT)
After cleaning, the wound is not closed with a stitch but can be vacuumed: the device drains out the contents of the injury and keeps the wound closed until next treatment. In a randomized study of limb fire wounds, vacuum did not surpass conventional dressings, so it is chosen by the surgeon as indicated.
02
Early microsurgical reconstruction.
The wound is not left for months to heal by secondary tension: when it is clean and the infection under control, it will be closed; undue delay increases the risk of complications.
Free composite tissue flaps
Instead of closing the wound with skin flaps, microsurgeons transplant large tissue complexes from another part of the body. For example, for limb reconstruction they use an ALT-flap (thigh) or a flap of your widest back muscle.
Vascular and nerve suturing under a microscope
Surgeons restore the mainstream blood flow with venous autografts, and damaged nerves are sutured "end-to-end" if ends come together without tension; a nerve defect is covered by insertion of the patient's own nerver, while minor defects in sensitive nervers are sometimes served up with biodegradable conduit tubes that guide fiber growth.
03
Bone reconstruction and 3D modeling.
The gunshot wounds often cause massive bone defects.
Indunal membrane method (Masquelet)
Two-stage technology. In the first stage, a cement spacer is placed in the bone defect. A dense, vascularly rich membrane forms around it over several weeks (usually 4–8). At the second stage the spacers are removed and the gap inside the membrane filled with patient’s own bone crumb. The membrane protects the graft and promotes bone coagulation.
Individual 3D printed titanium implants
If the injury has destroyed facial, skull or pelvic bones, a CT scan is used to make an implant in the shape of the lost fragment, which is fixed with screws and restores the body contour.
04
Regenerative Medicine.
Fire wounds are directed towards the formation of heavy, sequestered scarring that limits movement.
Fat grafting
Transplanting the patient's own fat into the scar area. It can soften the Scar and smooth out recesses; evidence is limited, so effect evaluated individually.
05
Reinnervation and preparation for bionic prosthetics
If the injury resulted in amputation, surgery prepares the doughnut for modern prosthetics.
TMR (target muscle reinertivation)
The nerves that went to the lost arm or leg are sewn back into healthy coccyx muscles. In many patients this reduces phantom pain and cocky pain, although not in all and not always completely, and provides clearer signals for controlling the bionic prosthesis
05 / HOW IT BRACKS
What happens to the wound and the bone.
The gold marks the tissue that the defects restore.
01
Zones of the gunshot wound.
Around the canal, a bullet or fragment of tissue is destroyed immediately and in the wider area around it some tissue may die within days. Therefore, the wound is cleaned several times and closed only when it has become clear.
02
Negative-pressure wound dressing
A sponge is placed in the wound, covered with a sealant film and connected to an apparatus that creates thinning. It sucks up the contents of the wound and keeps the injury tightly closed; the dressing is changed every few days.
03
Induced membrane method.
A cement spacer is placed in the bone defect, and within a few weeks (usually 4-8) a vascular membrane forms around it. The spacers are then removed and the membrane filled with patient’s own bone crumb — which gradually grows into bone.
The schemes are simplified and not scaled up.
06 / PHASE
How treatment proceeds after injury.
Fresh wound
Stop bleeding, stabilize fractures, re-clean the wound, vacuum bandages if necessary — in a clinic or hospital.
Closure of wounds
Once the wound is clean, it is closed without unnecessary delay using a skin graft or tissue flap.
Recovery of bones, nerves, receptacles
Phases: Inducular membrane method, two stages with intervals usually of 4 to 8 weeks.
Pieces, debris, function
The rubies operate after ripening, the debris after testimony, and, in parallel, rehabilitation.
07 / AFTER OPERATION
How the recovery is going.
Terms depend on the number of transactions; the exact plan is individual.
Hospital stay
After major reconstructions, a few days of surveillance of the blood flow in the bed.
Bandages and vacuuming
The vacuum bandage is changed every few days, the sutures are usually removed in 1-2 weeks.
Rehabilitation
After limb surgery, splinting and therapeutic exercise are essential for restoring movement.
Between Stages
Usually there are weeks or months between operations; the plan of the phases is explained in advance by the surgeon.
08 / Rebuilding
Rehabilitation after injury.
A healed wound is not the end of treatment: movement, pain, and psychological well - being are restored together.
01
Early rehabilitation by the team.
Shared plan
Post-injury rehabilitation is usually conducted by a team of surgeon, physical therapist, occupational therapy and psychologist working on the same plan. Reviews of multiple trauma studies have recorded improvements in function shortly after multidisciplinary recovery, though the quality of evidence ranged from very low to moderate. Better function was associated with early start of rehabilitations, while early recovery was linked to shorter hospital stays.
02
Chronic Pain
How often
In a meta-analysis of 43 studies (5,601 patients), chronic pain after severe leg injury occurred in 63% of the cases – approximately as common after amputation (64%) and limb preservation (72%). Among military personnel with amputations following combat traumas, phantom pain occured in about 57%, coccyx pain — in around 89%.
What do they do with it?
Pain should be assessed in conjunction with psychological state: phantom pain has been associated in studies with coccyx pain and psychologic disorders. Surgical methods for cocsy — on the page. " Boonic Prostheses ".
03
Psychological assistance
First three months
A meta-analysis found that psychological support initiated within three months of the trauma reduced symptoms of PTSD and depression to a mild to moderate extent; no overall effect was found on anxiety. Exposure-based methods and cognitive behavioral therapy worked best, with information only having little impact.
Treatment of PTSD
The Department of Veterans Affairs and U.S. Defense (2023) guidelines recommend structured psychotherapies primarily — prolonged exposure, cognitive trauma therapy, EMDR — and do not recommend benzodiazepines or cannabis.
09 / INSTALMENT
How much does it cost.
The cost of the operation depends on the volume, number of periods and days in the hospital; the surgeon calls it after examination.
For military and veterans, there are special benefits.
Operations for the UFA servicemen are carried out by the clinic with funding from charitable foundations and in cooperation with military hospitals. Take your medical ticket and a doctor's report to the consultation.
10 / PACIENT SHOTS
From the first call.
Conversations and materials
You describe the request and, if you have it, you provide the results of the previous examination and treatment.
Consultation and evaluation
The doctor determines what situation we are in, what circumstances we need, what we need, and what his limitations are.
Reorganization
It discusses the next steps, the sequence of phases and the issues of reconstruction.
You don't live in Kiev or abroad?
Patients come from all over Ukraine and abroad.
11 / For Consultation
What is worth discussing?
01
When and how did the injury happen?
02
What kind of surgeries have you done?
03
What's bothering you now: wound, pain, movement, view?
04
Is there a C.T., a statement and a description of the operations?
05
Are there any debris left, and where?
06
What medication are you taking now?
12 / FOOD AND REPLIES
Frequently Asked Questions.
The short answers are that what suits you is what the doctor will tell you.
Should all the shrapnel be removed?
No. They remove fragments that hurt, cause infection, lie in the joint or near a nerve, or increase blood lead levels. Others are often left and observed. The decision is made after examination and CT scan.
What is the danger of the remaining fragments?
Mostly nothing, but rarely they migrate or cause infection; lead poisoning is possible primarily from bullets, especially in the joint.
The wound hasn't been running for months — what to do?
See a surgeon: the cause may be bone infection, fragments or lack of tissue. After examination, the wound is cleaned and covered with flaps.
How many surgeries will it take?
After complex injuries, treatment is usually staged: from one operation for a small wound to several operations for bone and tissue defects. The surgeon explains the plan of steps in advance.
When can you operate on the scars after the injury?
Planned – after the scars have matured, usually not earlier than a few months. Earlier – if the Scar limits movement in the joint.
Does surgery help with phantom pain?
Can help: transfer of coccyx nerves to healthy muscle (TMR) in many patients reduces phantom pain and cocky pain, although not in all or always completely.
Do you treat the military?
Yes. Operations for IDF servicemen are carried out by the clinic with funding from charitable foundations; details will be explained by administrator.
Negative pressure wound therapy versus standard treatment in patients with acute conflict-related extremity wounds: a pragmatic, multisite, randomised controlled trialThe Lancet Global Health, 2020doi:10.1016/S2214-109X(19)30547-9 ↗
Negative pressure wound therapy for combat-related extremity vascular injuries: clinical experience from the war in UkraineScandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2025doi:10.1186/s13049-025-01502-3 ↗
War as a teacher: Experiences of facial reconstruction with anterolateral thigh flap during the Ukrainian warJournal of Stomatology, Oral and Maxillofacial Surgery, 2025doi:10.1016/j.jormas.2025.102407 ↗
Masquelet's induced membrane technique in the upper limb: a systematic review of the current outcomesJournal of Orthopaedics and Traumatology, 2025doi:10.1186/s10195-024-00815-w ↗
Pain and Functional Outcomes following Targeted Muscle Reinnervation: A Systematic ReviewPlastic and Reconstructive Surgery, 2024doi:10.1097/PRS.0000000000010598 ↗
Retained bullet removal in civilian pelvis and extremity gunshot injuries: a systematic reviewClinical Orthopaedics and Related Research, 2013doi:10.1007/s11999-013-3260-8 ↗
Systematic review of multidisciplinary rehabilitation in patients with multiple traumaBritish Journal of Surgery, 2012doi:10.1002/bjs.7776 ↗
Multidisciplinary rehabilitation in persons with multiple trauma: A systematic reviewJournal of Rehabilitation Medicine, 2020doi:10.2340/16501977-2737 ↗
Early psychological interventions for posttraumatic stress, depression and anxiety after traumatic injury: A systematic review and meta-analysisClinical Psychology Review, 2018doi:10.1016/j.cpr.2018.05.001 ↗
The Management of Posttraumatic Stress Disorder and Acute Stress Disorder: Synopsis of the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice GuidelineAnnals of Internal Medicine, 2024doi:10.7326/M23-2757 ↗
A systematic review of the prevalence of postamputation and chronic neuropathic pain associated with combat injury in military personnelPain, 2024doi:10.1097/j.pain.0000000000003094 ↗
Prevalence of chronic pain after severe lower limb injury (SLLI): A systematic review and meta-analysisInjury, 2024doi:10.1016/j.injury.2024.111495 ↗
Signs of sepsis and wound infection — for the NHS. The rest — research and reviews on methods on the page, including experience from the war in Ukraine.
VALIKHNOVSKI SURGERY PARTNERS
Your case deserves attention.
Start consulting to see what questions and materials are needed for the evaluation.
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FIG.01 / CONCEPTUAL VISUALIZATION
FIG. 01.1 / INTRODUCTION