In an operating room at the Ivano-Frankivsk Regional Clinical Hospital in Ukraine, Canadian plastic surgeon Matthew Brace has removed a piece of rib, as well as a flap of skin from his patient's forehead, to reconstruct Andriy Djychka's nose.
Mr. Djychka lost half of it, along with an eye, defending his country on the front lines.
The procedure will not be the end of the surgical road for Mr. Djychka. Dr. Brace said he will need additional procedures, but the first phase went well.
Three and a half years after Russia's full-scale invasion of Ukraine, soldiers like him are reeling from the physical and interpersonal fallout from their injuries. Some are unrecognizable, even to their families, after losing bone and soft tissue to bullets and shrapnel.
Reconstruction surgeries are not simply about restoring faces. They are also about rebuilding confidence and helping patients find a new way to get on with their lives.
Earlier this month, Dr. Brace and several other Canadian surgeons and nurses returned from a days-long mission to perform facial reconstruction surgery.
The team convened in Krakow, Poland, then travelled to the Ivano-Frankivsk hospital, about 600 kilometres southwest of Kyiv. Their work was done through the Face the Future Foundation, which conducts missions in different parts of the world.
The foundation is the brainchild of internationally lauded Canadian head and neck surgeon Peter Adamson. He launched it almost three decades ago to ensure that patients in developing countries receive surgery for complex facial deformities.
Face the Future visits Ukraine twice a year and plans to return in the spring.
Dr. Brace, who lives in Guelph, Ont., has now been on three missions. He sees the work as the "purest form of medicine" - surgeons like him are trying to help people restore aspects of their appearance as well as aid in their reintegration into society.
"It's the thing that makes me feel like I'm exactly where I should be, doing exactly what I should be doing," he said.
Dr. Adamson has pledged to help restore the faces of as many Ukrainian soldiers as possible, calling those who have fought on the front lines heroes.
Many have suffered devastating injuries, he said.
"Yet the resilience and courage that they show is really quite remarkable," he said, adding that the soldiers are grateful that they have not been forgotten.
And while he can't claim to walk in their shoes, he tells them: "We can walk shoulder-to-shoulder beside you."
In addition to helping the wounded, North American surgeons and nurses working with Face the Future collaborate with their Ukrainian colleagues to diagnose complex injuries, plan treatments and perform intricate reconstructive surgeries.
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Khristie Morrell, a Toronto-based registered nurse who works in private practice and specializes in plastic and reconstructive surgery, plays a central role in securing equipment and supporting logistics for the mission.
She has also developed "train the trainer" courses for Ukraine. For her, the educational aspect of the work is key.
"I think that's a huge part of why I keep going back," she said, adding that she has fostered a bond with individuals on the ground in Ukraine who started off as strangers and became friends and family.
Dr. Adamson said the foundation intends to continue supporting Ukraine in the years ahead.
He said it plans to be there after the war ends, whenever that might be, and anticipates several years of work ahead for patients who require multiple procedures.
He hopes to leave wounded soldiers with lasting hope, so they can carry on after all they have endured.
"I'm proud that we can be there and that Canada's flying its flag there."