For Some Wounded in Ukraine War, Surgery Helps Rebuild a Sense of Self

The face is the window to identity and emotion. To have it disfigured is not merely to be wounded, but to be unmoored from one’s own sense of self.

Since Russia’s invasion of Ukraine in 2022, many Ukrainians have suffered grievous facial injuries, a brutal testament to the power of modern weaponry and the vulnerability of the flesh.

“A soldier loses a leg, and society calls him a hero,” said Dr. Andrii Kopchak, the head of the department of maxillofacial surgery at Bogomolets National Medical University in Kyiv. “But lose your face? You become a ghost.”

These advances build on a century of innovation, from Harold Gillies’s pioneering surgery to mend faces broken in the muddy trenches of the Somme in World War I to today’s digital modeling to repair bodies mangled in the bloody battle for Bakhmut.

The goal has long been to restore function, while also giving hope to the wounded.

For many of Ukraine’s wounded, breakthrough surgical treatments followed earlier, botched operations that, in effect, had to be undone and redone. Like much of the Ukrainian war effort, the medical struggle has been marked by improvisation and experimentation.

The New York Times spent two years visiting men and women whose lives have been shattered, and meeting the doctors and volunteers working to help them.

Battling to Return to Battle

Mr. Melnyk, 32, was wounded in 2023, when his unit stormed a Russian hilltop position and, after intense combat, seized control of it. During the battle, shrapnel shredded his face.

“All the nerves on the right side of my face were severed,” he said. “All the bones were shattered. I could not see out of my eye.”

The evacuation team could not reach him at first. Russian artillery and drones made movement impossible. For nearly 23 hours, he fought on through the pain.

“When you’re in an enemy trench, you have two options: either sit down, pity yourself and die, or do everything you can,” Mr. Melnyk said.

Once he reached safety and the adrenaline was gone, the cruel reality of his injuries set in.

He said some of the nurses who saw him early on had the attitude, “You’re going to die anyway,” and showed no interest in treating him.

After the Napoleonic wars, soldiers described killing comrades with mutilated faces, justifying their actions by saying that death was better than living with such misery.

In World War I, soldiers who survived facial trauma were often shunned by society — a stigma that doctors in Ukraine said exists today.

Mr. Melnyk underwent round after round of surgery. Plates were incorrectly placed, abscesses formed, and shrapnel was left inside.

It was only after nearly two months that volunteers from the “Doctors for Heroes” project intervened, helping transfer him to a new hospital and a new program to reconstruct his face.

“We scan the skull, create a digital model and print titanium plates layer by layer,” said Dr. Kopchak, pulling up a CT scan of a patient’s smashed jaw. “It’s like rebuilding a shattered vase. Every fragment matters.”

Mr. Melnyk has endured more than 50 operations. Last fall, he was preparing for what he hoped would be the last.

“The main thing was to be able to chew and eat because that’s energy for a person, especially a soldier,” he said.

He has since returned to duty at the front.

No Place Is Safe

As the father of young children, Mr. Tkachenko, a factory worker, was not required to do military service. But he enlisted after Russia invaded, and he spent months in brutal combat before returning to his village, Novosofiivka.

It was just weeks later, when he, his wife, Julia, and their 20-month-old daughter were visiting his parents, that the missile struck. The explosion that killed his parents also injured his wife and daughter, hurling the little girl more than 20 yards.

When he regained consciousness, Mr. Tkachenko, now 37, did not recognize the face in the mirror.

“It was very different,” he said from a hospital bed in Kyiv, still struggling to find words. “I couldn’t feel parts of it. I couldn’t even talk.”

He had suffered severe damage to his skull and facial bones.

“Shrapnel was embedded deep inside his head — one piece was even protruding when he arrived,” said Roman Kozak, the surgeon who performed the initial reconstructive surgery last year.

It was an exceedingly complex case, the doctors said, that showed both the possibility and some limitations of technology.

Dr. Kozak and his team collaborated with bioengineers to digitally reconstruct Mr. Tkachenko’s shattered face. With 3-D printing, they created implants tailored to his unique facial structure, to hold bone fragments in place.

“Now, we are preparing for a second surgery to reconstruct his lower eyelid and remove the metal plates, which pose a risk of infection due to their proximity to the nasal sinuses,” Dr. Kozak said.

Back From the Dead

The first thing Ms. Leonidova, now 45, remembers after being injured was the feel of cold steel pressing against her cheek. She did not know where she was, only that it was dark and a stench hung thick in the air — a mix of antiseptic and death.

All around her were corpses.

“I was taken as ‘cargo 200,’” she would later recall, using the military code for the dead.

She had been mistaken for another fatality from shelling that tore through her small town in eastern Ukraine in 2014, during the opening chapter of what would grow into the deadliest war in Europe in generations.

She soon fell into a coma, waking after two months. Her right eye was gone, her jaw shattered, her body scarred.

“I couldn’t understand anything,” she said.

Before the war, life in Zuhres, her village near the Russian border, was marked by simple pleasures. She was a mother and a factory worker, tending flower beds between shifts at the plant.

“Our whole region is filled with roses,” she recalled. “The fragrance of cherry blossoms, the Blue Lake, the quarries, the river. It all inspires you.”

In early 2014, violence engulfed her region, known as the Donbas. Russia fomented a separatist uprising in the Donbas, where militias aided by Moscow began seizing territory.

She was returning from a chicken farm to distribute food to local residents when Russian warplanes bombed the road.

“My first thought, piercing like pain, was ‘the children,’” she said. “Dying isn’t scary; I know that now,” she added. “The fear is leaving your children alone in this world.”

Her children later escaped Russian-occupied territory, joining her first in Kharkiv and now in western Ukraine.

She has undergone countless surgeries, many to correct earlier operations. Doctors from the American charity Face the Future used a titanium implant, tailor-made, to rebuild her shattered eye socket.

Ms. Leonidova now wants to study psychology and open a center to help others wounded in war.

Her darkest thoughts have faded. She and her boyfriend, Nazar Zhurba, got engaged.

“I’m a tough woman — titanium facade, steel bite, and the stare of a pit bull after a fight, creating miracles like Medusa Gorgon,” she said with dramatic flourish. “My gaze turns people to stone.”

Not Wanting to Be Seen

For such patients, “the psychological toll is relentless,” Dr. Kopchak said. “Imagine looking in the mirror and not recognizing yourself. Now imagine your wife or child seeing you that way.”

He has watched marriages collapse and families fracture.

“We have one psychologist for hundreds of soldiers,” he said. “He’s a good man, but he wasn’t trained for this.”

International collaboration has been a lifeline, he said.

Finnish surgeons traveled to Kyiv to perform complex nerve grafts. French experts shared protocols for orbital reconstruction. The group “Face to Face” played a critical role.

Mr. Poplavskyi’s first surgery last year took 17 hours.

“We are coping because of the doctors,” his sister, Dina Yakubenko, said.

Medical teams are preparing to use stem cell therapy, hoping to improve his vision.

Despite all the suffering, his family said, Mr. Poplavskyi, now 40, remains mentally stable and, most importantly, they are together.

“We are his psychological support,” his sister said. “And we are the psychological support for each other.”