MADISON – Maks Makarenkov couldn’t help but smile on car rides through the capital city. He saw homes with blue and yellow flags pinned in their windows or dangling from flagpoles.
“Seeing the Ukrainian flags here, it touches my heart,” Makarenkov said. “In this war, we feel the American support.”
It was Makarenkov’s first time in the U.S. but he wasn’t there to sightsee. He and five other Ukrainian surgeons were learning the nitty-gritty of microsurgery during a two-week intensive training at the University of Wisconsin-Madison School of Medicine and Public Health.
Makarenkov, 29, has brown hair and a boyish face that hides the horrors Ukrainian surgeons have seen over the last four years: Men blasted by missiles missing multiple limbs. Drone strikes shredding civilians’ hands. Soldiers who lost legs but are still seeking to go back into battle.
Microsurgeons use surgical magnification and microscopes to repair small structures, like blood vessels and nerves. It may also involve transferring tissue from one part of the body to another. A common procedure at UW Hospital, for example, takes skin and fat from the abdomen to reconstruct the breasts of a cancer survivor who underwent a mastectomy.
In a war setting, microsurgery can equate to spare parts surgery. For a patient who loses a thumb, a microsurgeon can give them a hand capable of grip by removing the patient’s big toe and reattaching to their hand. Or they may take tissue from one part of the body to repair a leg wound in a way that saves someone’s knee, boosting the chances of a working prosthetic.
Microsurgery is a highly specialized discipline within plastic surgery. Some U.S. medical schools don’t even teach it.
UW-Madison, however, has built its microsurgery program into a global training hub. Demand comes from all corners of the world, especially from war-torn countries or developing nations.
Samuel Poore, the chair of the plastic surgery division, has traveled from Vietnam to South Africa to Egypt on training trips. Hundreds of other surgeons worldwide have learned through the lab’s livestreaming sessions.
Ukraine is just the latest to benefit from the university’s expertise. Before Russia invaded in 2022, Makarenkov specialized in orthopedics and had long cast plastic surgery as the cosmetics department. Now facing hundreds of injured patients per month, he has been thrust into performing procedures he never imagined he would do and sees microsurgery as a way to save more lives. The YouTube videos he watched to teach himself weren’t cutting it.
“Any surgeon in Ukraine right now is a trauma microsurgeon,” he said. “We have to know how to do this.”
UW’s head of plastic surgery came from family of doctors
Before Poore became the face of UW’s global microsurgery education program, he was the youngest of seven children growing up in the mountains of Flagstaff, Arizona. Both of his parents worked in the medical field. Both had humanitarian tendencies.
His mother had been a nurse midwife in the Frontier Nursing Service, riding on horseback throughout rural Kentucky delivering babies. His father was a physician in Northern Arizona, often treating Navajo tribal members who couldn’t afford to pay. When his parents retired at 80, they opened a free medical clinic.
A massive Navajo rug hangs in Poore’s office, a reminder for Poore to live generously.
His own medical career started with rejection. All of the medical schools he applied to turned him down. Lost, he took a job researching bird flight at Brown University in 1993.
Poore reapplied to medical school. He graduated from Brown in 2004. A plastic surgery residency at UW-Madison followed.
Plastic surgery wasn’t initially on his radar. The specialty conjures images of doctors in spiffy suits driving luxury cars, thanks to “Dr. 90210,” “Nip/Tuck” and other TV shows. The field’s reconstructive work is often overlooked, but Poore had learned a bit about it while studying nerve repairs in birds.
The most interesting papers he read came from plastic surgeons.
Cheap, portable microscope paves way for worldwide microsurgery training
Like many scientific endeavors, the effort to build a global microsurgery education program began with failure.
Transporting a $300,000 standard operating room microscope abroad was a no-go. But some type of magnification system was needed on the training trips. A standard microsurgery suture is thinner than a human hair, and the needle is about the size of a grain of rice, but finer.
A few papers had been published on iPhones being used as microscopes for microsurgery. Poore tried it in Rwanda.
“It was not at all a success,” said Aaron Dingle, an assistant professor in the lab.
Cell phones don’t have good depth perception, so the surgeons couldn’t see where their hands were in relation to the blood vessels and sutures on the iPhone screen.
The lab explored other ideas, from virtual reality goggles to a camera and webcam setup. None worked. The winner: a low-cost, portable microscope that could pass through airport security.
Medical student Sahand Eftekari made the first model using popsicle sticks and a pair of butterfly-watching binoculars. The microscope was rudimentary but it worked – and it only cost about $1,000 to produce.
But the lab can only make so many of them with its 3-D printer. And Poore tended to leave one or two microscopes behind on the dozen trips he’s made abroad, so the surgeons could continue training.
“I’m a horrible businessman,” he said with a shrug.
The lab plans to launch a nonprofit, WiscVision, this fall to get microsurgery tools into the hands of more plastic surgery residents and medical students around the world. A manufacturer is working with the Wisconsin Alumni Research Foundation, the university’s patent-licensing arm, to mass produce and distribute the portable microscopes.
These budding microsurgeons, however, still need training. Poore can only take so many trips in a year, and his lab has limited resources to host groups.
Weifeng Zeng, a microsurgeon who works with Poore, started livestreaming microsurgery lessons in 2022. Hundreds of students, from Thailand to Chile to Uzbekistan were eager to learn, even if it meant tuning into Zeng’s sessions in the middle of the night.
Plastic surgery field emerged through warfare
The roots of reconstructive surgery trace back to World War I.
A new style of warfare involving machine guns and heavy artillery led to a rise in horrific facial injuries. Surgeons on the frontlines would sometimes stitch together a soldier’s wound without considering the amount of flesh that had been lost, according to the National Army Museum in London. As scars healed, the skin tightened, pulling their face into a grimace. Former soldiers would wear masks or veils to hide their disfigured faces.
Surgeon Harold Gillies set up a special ward for facial wounds at his Cambridge hospital and eventually opened a dedicated hospital. There, he developed new techniques to reconstruct soldiers’ faces. His work laid the foundation for modern plastic surgery.
More advances in the microsurgery field emerged through warfare. Nerve repair reconstruction improved during World War II.
Better tactical gear during the Afghanistan and Iraq wars protected soldiers’ core internal organs from explosives but left their limbs exposed. That meant more soldiers survived, but there was a greater need for better-functioning prosthetics.
Dingle’s research has moved into limb transplantation, where surgeons replace someone’s missing limb with a deceased donor’s limb.
The Russia-Ukraine war will advance microsurgery even more, Dingle said.
Makarenkov and others face a high volume of severely injured patients, more than an American surgeon might see in a year. They are trying anything to keep their patients alive. One experimental technique involves scanning the uninjured side of someone’s body to 3-D print implants that will replace bones on the injured side.
“This stuff exists, but it’s not common here,” Dingle said. “There are all these steps that need to be done before it becomes mainstay in modern Western civilian medicine. Those changes will happen in Ukraine. They’ll redefine medicine in 10 years’ time.”
Before Ukrainians redefine microsurgery comes practice. Lots of practice.
The surgeons pulled packages of chicken thighs out of the fridge, unwrapped the plastic film and picked up their micro forceps. In the first week of the Ukrainians’ training, poultry was the patient.
It’s a perfect vehicle for practicing microsurgery skills. Bone-in thighs are cheap and have blood vessels intact. Blue dye injected through a catheter mimics blood, helping surgeons confirm their sutures won’t leak.
Makarenkov was one of two civilian surgeons, along with four military surgeons, who made the trip, which was funded by a Rotary International grant.
Makarenkov works at a hospital in Dnipro, a major industrial hub in the south-central part of the country that is regularly subjected to mass waves of missile attacks. On his phone, he pulled up a photo of his city being bombed, a plume of smoke curling into the sky. His little brother had texted it to him that morning.
“Almost every day, this happens,” he said in an interview through a Ukrainian translator.
Anya Ubovenko, 29, was working in an operating room when a missile attacked the other side of her hospital in Kyiv about a year ago.
“Before the war, we didn’t have a need for prosthetic surgery,” she said. “Now, we’re operating on children. We need to learn new techniques.”
Ukrainian nonprofit connected surgeons to UW-Madison for medical training
Makarenkov was barely out of residency when the war began. He essentially lived at the hospital in the first few months of the war. The caseload was high, about 150 war-related patients per day. He slept in an empty patient room when he could find time. His caseload has since dropped to about 50 patients per day.
He felt lucky to be able to further his education in Madison. The group graduated from chicken thighs to cadavers in the second week of training.
The trip also served as a way for the Ukrainians to decompress in a place without the constant fear of drone strikes. They sang karaoke. They attended a Milwaukee Bucks game. They cooked a surprise dinner for Poore, Dingle and Zeng one evening, a menu featuring pierogies and borscht.
“The name doesn’t sell it,” Poore said of the beet soup beloved by Ukrainians. “It was delicious.”
Poore personally hosted the six surgeons in his home and at a rental unit he owns.
The gesture stuck with Yakov Gradinar, a former Ukrainian doctor who organized the surgeons’ trip. He founded the Protez Foundation, a nonprofit providing prosthetics to Ukrainians who lost limbs during the war. The organization has expanded to bring Ukrainian doctors to the U.S. for medical training.
Convincing hospitals to host them can take some persuasion, he said. Some are unwilling to navigate the red tape involved when doctors have military affiliations. Others fear being connected to the war will be seen as too political.
Poore was not one of those people.
Just a few weeks after Makarenkov and the others returned home, Gradinar got an email. It was Poore asking when the next wave of Ukrainian surgeons could come to UW-Madison.
Kelly Meyerhofer has covered higher education in Wisconsin since 2018. Contact her at kmeyerhofer@gannett.com or 414-223-5168. Follow her on X (Twitter) at @KellyMeyerhofer.
This article originally appeared on Milwaukee Journal Sentinel: In fight to save Ukraine’s wounded, surgeons learn skills at UW-Madison
Reporting by Kelly Meyerhofer, Milwaukee Journal Sentinel / Milwaukee Journal Sentinel
USA TODAY Network via Reuters Connect
