In late April, surgeon David Nott was in London – far from Ukraine. But that didn’t stop a man hit by an explosion in the war-torn country from helping save his leg.

Oleksandr, the doctor who performed the surgery in motion, had never done complex procedure before. However, about a week ago, he had seen Professor Nott demonstrate how the operation was performed in the Ukrainian hospital.

Oleksandr took a photo of the wound with his cell phone and sent it to Nott, who had recently returned to the UK. An experienced British war surgeon confirmed that the operation was indeed necessary. He also sent a video to his Ukrainian colleague explaining how to proceed.

“I was pretty nervous and it was a slow, step-by-step surgery, but it went well thanks to David Nott,” says Oleksandr.

Born in Wales, Nott has worked in conflict zones in places like Afghanistan, Iraq and Syria.

As a consultant surgeon at St Mary’s Hospital in London, he made Ukraine his final destination on a mission to train doctors to treat war wounds.

With Russia bombing cities after the explosions, Ukraine’s hospitals are now receiving large numbers of casualties.

“This is the worst way to attack by bombing,” Professor Nott says in his first interview after returning from Ukraine. “It deals massive damage and is behind horrific injuries.”

Injuries are usually caused by shrapnel hitting soft tissue, bones and entire limbs.

The doctor explains that the shock wave itself caused extensive damage. The “strong wind” following the explosion can cut limbs. Being thrown into buildings can also cause extensive trauma.

Barotrauma – physical injury caused by changes in pressure during an explosion – is of particular concern given Russia’s use of thermobaric weapons, also known as vacuum bombs.

These weapons can cause bleeding in the brain and lungs, causing victims to spit blood. They can also rupture the eardrums and puncture the intestines.

While Nott says there are “north, east, southeast, west” all over Ukraine, he doesn’t want to talk about hospitals or specific areas he’s visited for fear that Russian forces will attack them – and that’s exactly why the BBC reads in full Oleksandr quoted at the beginning of the report. does not use his name or exact location.

During the war in Syria, the British surgeon used a Skype connection from his London office to guide an operation in the city of Aleppo. Days later, the same hospital was bombed. He says he will never know if the two facts (video call connection and attack) are linked.

The professor now calculates that 115 hospitals in Ukraine were bombed by Russia.

“Blowing up hospitals and killing doctors is also a real weapon of warfare and is simply despicable,” he says.

While Nott was in Ukraine, he brought as many doctors as possible into operating theaters to see him perform surgery on typical warzone injuries, including filling holes in arms and legs, skin grafts, and sealing exposed bones in fractures.

But the mission, a joint effort between the David Nott Foundation and humanitarian group UOSSM International, did not end when the surgeon left the country. Shortly after, he would mentor Oleksandr remotely before undergoing complex leg surgery, as described above.

The procedure involved removing a flap of skin located behind the patient’s knee to close a wound and prevent infection from entering due to an exposed broken bone.

“These are very difficult operations and cause problems when it goes wrong,” Nott says.

But despite these difficulties, the result was “miraculous,” he continues. “The surgery went very well.”

Oleksandr says it’s important to have the advice of someone with practical experience on the subject. It is comforting for us to be told that everything will be alright.”

The Ukrainian doctor showered Nott with praise, saying he had shown “how ordinary doctors can fight on the front lines”.

Knowing how to perform such procedures is “very necessary in our case,” Oleksandr says, because there are so many grenade injuries and open fractures that need to be treated.

Through her charity, Nott has translated into Ukrainian several slides and videos on how to treat war wounds that “go to as many doctors’ cell phones as possible.”

He also hopes that professionals like Oleksandr will pass on what he has learned. “Until many people learn how to do it, it will train other people how to do these procedures, who will share the knowledge with more people,” he believes.

Unfortunately, the demand for these surgical skills in Ukraine does not seem to end anytime soon.

Earlier this month, the country’s foreign minister said battles in the eastern Donbas region would resemble World War II with the use of “thousands of tanks, armored vehicles, aircraft and artillery”.

For Nott, scenes from cities like Mariupol are reminiscent of events he witnessed earlier in Aleppo.

“Exactly the same as Syria, with the same tactics,” he compares.

“While we were in Aleppo in 2016, it was completely razed and completely destroyed.”

Oleksandr said he had healed “terrible wounds” he never expected to see.

“We want to treat normal traumas like grandparents who need joint replacements, common fractures,” he says. “We do our job every day and no matter what happens, we will stay here and do what needs to be done.”