Trauma surgeon David Nott was in London on Thursday, a long distance from Ukraine. That didn't stop him from assisting in the rescue of a guy whose leg had been trapped in an explosion in the war-torn nation. The doctor who actually conducted the operation, Oleksandr, has never done anything like it before. However, he had just witnessed Prof Nott show how it was done inside a Ukrainian hospital a little over a week before.

        So Oleksandr used his smartphone to take a photo of the wound and emailed it to Prof Nott, who had just returned to the UK. The procedure was determined to be required by an experienced British army surgeon. He'd also shown Oleksandr a video that walked him through the process. "I was worried, and it was a slow, step-by-step procedure," Oleksandr admits, "but everything went well due to David Nott."

        Prof Nott, who was born in the Welsh town of Carmarthen, has previously worked in war zones such as Afghanistan, Iraq, and Syria. Fortunately for Oleksandr and his patient, a consultant surgeon from London's St Mary's Hospital had made Ukraine the next stop on his quest to teach doctors in the treatment of war wounds.

        As a result of Russia's bombardment and shelling of cities, Ukraine's hospitals are presently experiencing a high number of explosion injuries. "By just bombarding the opposition, it is the worst conceivable means of fighting the opposition," Prof Nott says in his first interview since returning from Ukraine. "It has a huge negative impact. It creates terrible, terrible harm." Shrapnel wounds to soft tissue, bones, and limbs are among them.

        According to him, even the shockwave from such a bomb might do significant harm. The "blast wind" it leaves behind can amputate limbs. Being hurled against a building might also result in serious injuries. Because of Russia's employment of thermobaric weapons, also known as vacuum bombs, barotrauma, or physical harm induced by changes in pressure after an explosion, is a major worry. These can result in brain and lung bleeding, leading individuals to cough up blood. They're also capable of perforating bowels and exploding eardrums.

        Prof Nott says he's travelled all across Ukraine, "north, east, south-east, west," but he won't specify which hospitals or locations he's been for fear of Russian forces targeting them, and the BBC won't use Oleksandr's full name or location for the same reason. He utilized a Skype connection from his London office to help with a surgery in Aleppo during the Syrian war, only for the hospital to be attacked a few days later. He has stated that he will never know if the two are linked.

        According to Prof. Nott, Russia has already attacked 115 hospitals in Ukraine. "Bombing hospitals and killing physicians is also a true weapon of war; it's disgusting," he argues. Prof Nott got as many specialists as possible into operating rooms to witness him do procedures on warzone injuries, including as plugging holes in limbs, grafting skin, and covering exposed bones, when he was in Ukraine.  

        However, the mission, which was a collaboration between his David Nott Foundation and the humanitarian organization UOSSM International, did not finish when he departed the country, since he would soon be mentoring Oleksandr remotely before the delicate leg surgery. A flap of skin from behind the patient's knee was used to seal a cut and prevent infection from spreading to the exposed bone. "They're quite challenging surgeries," Prof Nott explains. "They're not easy, and they go wrong and cause complications."

        Despite these obstacles, he claims the end outcome was "miraculous." "It was a huge success." "It's a comfort to us when he assures us it'll be OK," Oleksandr adds of having the advise of someone who has done the procedure before.

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        Prof Nott has "shown us regular physicians how to fight on the medical forefront," he claims. Because there are so many shelling injuries and open fractures to treat, Oleksandr thinks understanding how to do these procedures is "extremely vital in our scenario."

        Prof Nott's charity, the David Nott Foundation, has translated a series of slides and films on how to treat combat wounds into Ukrainian, "which got on as many physicians' phones as possible."
He also hopes that those he has taught, such as Oleksandr, would pass on what they have learnt. "He'll teach other people how to do it, and they'll teach other people how to do it, and maybe in the not-too-distant future, everyone will know how to do it," Prof Nott adds.

        Unfortunately, it appears that the demand for these abilities in Ukraine will continue to grow in the near future. Ukraine's foreign minister claimed earlier this month that the clashes in the eastern Donbas area will be reminiscent of World War II, with "thousands of tanks, armored vehicles, aircraft, and artillery."

        Prof Nott compares the sights emerging from places like Mariupol to what he saw in Aleppo earlier. "It's precisely the same as Syria," he says, referring to the techniques. "When I returned there in 2016, Aleppo had been entirely demolished; the entire city had been completely and utterly decimated." Oleksandr claims to be treating "terrible injuries" that he had wanted to avoid.

        "We'd like to treat typical fractures and routine trauma, such as grannies and grandpas who need joint replacements," he explains. "We're doing our work day by day," he continues, "and whatever happens, we'll stay at home and do what we need to do."