Some 25 war wounded from Ukraine ended up on the operating table of soldier and surgeon Vincent Stirler at Radboud university medical center in the last few years. ‘What civilians often do not realise is that soldiers are treated with the aim of allowing them to return to the battlefield as soon as possible.’

Between 30,000 and 50,000 Ukrainians have had a limb amputated since the Russian invasion in 2022. That is an alarmingly high number, says Vincent Stirler. But war is unfortunately disastrous for arms and legs.

Limb loss is nearly always the result of explosions,’ says the trauma surgeon. ‘Think mines, grenades, and missiles. Amputations are rarely caused by bullets.’

Stirler performed surgery on some 25 Ukrainian soldiers injured on the front line in recent years. At Radboud university medical center, he amputated arms and legs, but more often he tried to save limbs. ‘Amputation is not something we do lightly, but basically anyone can do it, if you know the steps to follow. It is much harder to save an arm or leg if it is severely damaged.’

Stirler specialises in these complex cases. He is experienced in reconstructing limbs where whole pieces of bone are missing, or where nerves and blood vessels have been damaged.

Network of assistance

Ukrainian war wounded come to Nijmegen via different routes. One of these is the Netherlands for Ukraine Foundation, which also hosts refugees and helps the injured. When a patient is referred to the foundation, calls are made to Stirler or his colleagues elsewhere in the Netherlands to ask who can perform surgery. ‘The foundation organises transport and shelter here. I say when I have time, and on that date the patient is brought to my polyclinic.’

A second route is through the European Union. Several countries form a network of assistance. At a medical hub in neighbouring Poland, a weekly list of injured people and their diagnoses is compiled. Member states can subscribe to this list. Patients are then distributed to countries and hospitals.

‘Every Wednesday a plane leaves and brings wounded to different countries. At Schiphol Airport, ambulances are ready to take the men to the relevant trauma centres.’

War injury

Nijmegen has the largest trauma centre in the Netherlands. Surgeon Stirler has a lot of expertise when it comes to complex trauma, but he is also passionate about helping soldiers. He himself is a colonel doctor, which means he works for the Ministry of Defence and can be deployed in case of conflict. By performing surgery on Ukrainian soldiers, the medical team of Radboud university medical center is improving their knowledge of war injuries.

‘War medicine is not the same as civilian medicine. What civilians often do not realise is that soldiers are treated with the aim of allowing them to return to the battlefield as soon as possible. They have to go back to the front, because the fighting must continue. Otherwise, the war cannot be won. It’s a different way of thinking.’

Of course, there are soldiers who are rejected because of severe loss of function, but others are expected to pick up arms again in the foreseeable future. Someone with a prosthetic leg may no longer be able to run, but they can still operate a drone.

‘There is a story going around about a Ukrainian soldier – I don’t know him personally – who didn’t lose his leg in an explosion, because he no longer had a leg to lose. Instead, he lost his prosthesis.’

3D printer

In a military hospital, doctors often have to improvise, getting by with the limited capacity and resources available. That appeals to Stirler. He recently launched the MANIAC (Military AI and Innovations in Acute Care) research group, which applies AI, VR, and other smart devices to deliver acute care in an innovative way. The 3D Lab Radboudumc, for example, has devised a system that produces sleeves for leg prostheses with nothing more than a laptop and a 3D printer.

‘This is a socket that you slide around a stump, and to which you then attach the leg prosthesis. The socket has to be made to size, which used to be done with plaster casts. We can now scan the shape and feed it directly into the computer. The printer then prints the socket. We have a project in Sierra Leone, where they can print these sockets under a tree, so to speak.’

Air raid alarm

Stirler’s team is also working with a new rehabilitation centre in Lviv, Ukraine. Since this centre also has a 3D lab, technical experts came to Radboud university medical center in November for training.

Some of the war wounded treated by the surgeon are convalescing in the Netherlands, others in Ukraine. He always asks his patients to send photos or videos of how they are doing. And sometimes he has a beer with Ukrainians staying here at the shelter. For him, war is not far away.

He believes that the Dutch should prepare much better for a potential conflict. ‘I always ask people: if the air raid alarm was to go off now, would you know where to go for shelter?’