Andriy’s Story

In 2014, eastern Ukraine was a battle zone. Russian forces had moved in to back the cause of separatist rebels, and the intervention soon escalated into an armed conflict that spared no one, least of all the Ukrainian soldiers on the front line.

Andriy Usach was one such soldier. The 36-year-old husband and father of two young daughters lived in Rivne, a historic city in western Ukraine. In July 2014, he voluntarily enlisted in the Ukrainian army and was deployed to the 80th Airborne Division of Lviv to defend the airport in Luhansk. His military unit quickly came under heavy artillery fire.

For four days, Andriy and his colleagues fought to hold the line against the rebel forces – at an enormous cost: Andriy suffered devastating shrapnel injuries, which ultimately resulted in the amputation of his left leg above the knee, the loss of bone and soft tissue in his left forearm and serious damage to his left lower face and jaw.

He underwent multiple operations to correct the damage, but none was completely successful. Andriy was left with extensive scarring of his lips, a left facial defect and a painful, infected, unstable jaw, which limited his ability to speak and eat.

Looking for ways to help the casualties of the Ukrainian war, the Canada-Ukraine Foundation organized a needs assessment and invited Dr. Oleh Antonyshyn, a Sunnybrook plastic surgeon of Ukrainian descent, to play a role. Dr. Antonyshyn proposed to lead a series of Canadian humanitarian surgical missions that would provide direct care to the wounded while increasing the capacity of local surgeons to manage craniofacial and upper-extremity trauma.

Sunnybrook’s Adult Craniofacial Program is one of the world’s best. Led by Dr. Antonyshyn, the program’s experts in plastic surgery and otolaryngology (head and neck surgery) collaborate on complex cases using high-tech imaging and “free flap” microsurgery to transplant bone, tissue and skin and reattach tiny blood vessels. Sunnybrook head and neck surgeons Dr. Kevin Higgins, Dr. Danny Enepekides and Dr. Tony Eskander are three of only a small number of surgeons in the world able to complete this kind of advanced reconstructive surgery using bone and tissue from the shoulder blade instead of the arm or leg – especially important in Andriy’s case, given the damage he had already sustained to his leg and arm.

Calavera Surgical Design, a Sunnybrook medical device company co-founded by Dr. Antonyshyn, was invited to create an ideal anatomical specimen of Andriy’s jaw for the surgeons to use as a guide during the operation. Using image data of Andriy’s injuries, Calavera’s engineers constructed a computerized 3D image of the repaired jaw complete with the missing bone and then printed it using a 3D printer.

In the first surgical phase, Drs. Higgins and Enepekides completed a tracheostomy, a surgical hole in Andriy’s windpipe to help manage his breathing during the surgery and his initial recovery. Dr. Antonyshyn then stepped in to prepare the jaw for transplant. He cleaned the infected mandible, removed the loose hardware and created a normal bite using new, custom-designed hardware based on Calavera’s 3D model. Throughout the next and final delicate phase of surgery, Sunnybrook’s head and neck microsurgeons harvested a portion of Andriy’s scapula and used it to re-build his jaw. They then spent multiple hours painstakingly reattaching the arteries and veins to his neck to ensure healthy blood flow to the donor tissue.

All told, the surgery took more than 13 hours.

Over the next three weeks, Andriy continued to recover with the support of his wife and the Sunnybrook team. When he returned home to Ukraine on January 4, 2018, he was mobile, free of stitches and wearing only a small bandage on his face. Best of all, he was pain-free, able to eat and speak normally and ready to celebrate the Ukrainian Christmas on January 7 with his family.