In his interview for the UNIAN news agency, Nazar Bahniuk, a prosthetics specialist at the UNBROKEN National Rehabilitation Center, spoke about prosthetics for people who lost their limbs as a result of the war, the peculiarities of the unique bionic arm prosthesis and its cost, as well as about the lightest prosthesis created with the help of a 3D printer.

The issue of rehabilitation of people who were physically affected by the war has become very pressing in Ukraine now. How can this problem be solved? After all, not all people can afford treatment and prosthetics abroad.

The UNBROKEN National Rehabilitation Center of Ukraine was created within the First Medical Association of Lviv specifically for patients who cannot afford these procedures abroad. The Center encompasses powerful physical, psychological and psychosocial rehabilitation. Among other directions of the Center’s activities, there is surgery, including reconstructive surgery, as well as orthopedics and robotic prosthetics.

The Center does not only install prostheses for Ukrainians affected by the war, but it will also manufacture them there. 3D printing of bone implants is also available.

Will these only be the military that will be treated here, or civilians that lost limbs for one reason or another will also be able to receive prosthetics?

The Center will help both military and civilian Ukrainians who suffered physical and psychological injuries as a result of Russia’s war against Ukraine. There will be more than 10,000 operations performed and more than 50,000 patients treated here annually. Patients with mine-explosive injuries and those who needed prosthetics used to be sent for treatment abroad. Now there is no need for that.

What does the prosthetics process look like in general?

It starts with the examination of the patient, taking the necessary measurements, negative plaster cast removal, making of a positive plaster cast, making of a prosthetic socket, intermediate fitting on the patient, assembling the prosthesis with a temporary prosthetic socket, and then following all the adjustments the permanent prosthesis is made.

What are these negative and positive plaster casts you have mentioned?

The negative one is winding a plaster bandage on the residual limb (the part of the limb that remains after the amputation, UNIAN) in several layers and the formation of the corresponding bone protrusions (for shin there is a different technology, but it is hard to explain). While the positive one is when a form is made from that plaster bandage, and plaster is poured into it. When the plaster bandage is removed from the cast, we have a plaster model of the amputated limb.

How long does it take to fit a prosthesis?

Could be one day, could be one month. Everything depends on the level of amputation, the condition of the patient, the technology used.

Is it necessary to change the prosthesis from time to time, provide maintenance services?

In Ukraine, in accordance with the law, a person can order a new prosthesis once every three years. There used to be exceptions for the employed – they could get a new prosthesis once a two years. But I’m not sure how it works now because the law has been amended several times. But, as you understand, a prosthesis is not a lifelong construction. That is, some can use it for five years, while others might have theirs broken in a year.

What does the replacement process look like?

We start everything from scratch, like the first time – just as I’ve explained before.

Do you provide prosthetics for children? If so, how is this process different?

At this stage, we do not have components for children’s prostheses. Ordering them is not a problem. The only problem is that children grow quickly and break prostheses very easily.

The first bionic arm prosthesis has been recently fitted in your Center. Can you please tell us about it and how it is unique?

This is yet another very important step on the way to saving Ukrainians in Ukraine. 33-year-old paratrooper Mykhailo Yurchuk who lost his limbs near Izium received the prosthesis. People who lose upper limbs usually have hooks or cosmetic prostheses fitted. The former allow people to work with their hands, the latter are used so as not to attract unnecessary attention. However, a truly high-quality solution for such people is a bionic arm prosthesis. Its special sensors allow reproducing familiar movements: a person tenses a muscle on an amputated limb and the wrist responds.

Are the components from abroad or local?

The components are from abroad, and this arm was bought for Mykhailo Yurchuk by the Ukrainian start-up Esper Bionic with the financial support of the IT company Symphony Solutions. By the way, the UNBROKEN National Rehabilitation Center together with the charity platform dobro.ua have launched a charity project “Prostheses for the Unbroken”. The project’s aim is to provide at least fifty Ukrainians affected by the war with the best bionic prostheses in the world. It needs to raise 100 million hryvnias for that.

And how much does one such prosthesis cost?

Starting from 60 thousand dollars. Everything depends on the condition of the patient, the kind of amputation. Therefore, each case is considered individually.

I recently read that the Center had installed a prosthesis printed with the help of a 3D printer.

Yes, we have installed the lightest in the world 3D-printed TrueLimb prosthesis. TrueLimb is a unique development of the American company Unlimited Tomorrow. This is a primary prosthesis. It can be fitted immediately after the healing of the wounds on the amputated limb. It has special sensors that react to muscle contraction allowing patients to control the prosthesis and move the fingers.

A man who had lost his arm as a result of a mine-explosive injury had this prosthesis fitted. This prosthesis is cheaper than the bionic one – the cost starts at 10 thousand dollars – but it was manufactured in the US.

Is this the first such prosthesis in Ukraine?

It is the second such prosthesis in the world received by the Ukrainian. 9-year-old Sasha from Bucha was the first one to have such a prosthesis fitted. The girl received a new arm in the USA with the help of the program of the First Lady of Ukraine Olena Zelenska. Other citizens of our country, including 41-year-old Oleksandr Yashuk from Zhytomyr, are waiting for the same arm. Oleksandr lost his arm in the battle near Chornobyl. The man says that for him receiving a prosthesis means an opportunity to be independent.

You have said this is the lightest prosthesis in the world. How much does it weigh?

Ranging from 1.1 to 1.5 pounds. This is a maximum of 675 grams.

What is the recently opened mobile prosthesis workshop in its essence?

This is a container with equipment where prostheses are made, as well as a room where patients have fittings and where plaster negatives are made. The patients learn to use prostheses in the rehabilitation department.

So this workshop is already operating?

It is. On the very first day, two patients had their leg prostheses fitted. Anyone who has lost a limb will be able to get a prosthesis here for free.

Is the equipment also foreign or domestic?

All the necessary equipment, components for prostheses and materials are from one of the best manufacturers in the world, the German company Ottobock. It all was given to us by the Maltese Aid Service with the support of the German government. Along with the workshop, the Center received 200 prostheses.

To what extent does a prosthesis enable free movement? I mean, do all prostheses help people avoid using wheelchairs?

Unless we are talking about hip amputation, then a person will be able to move. Walk up the stairs, walk on uneven roads… Generally speaking, living with a prosthesis is easier than moving around in a wheelchair.

Do you know anything about your former patients? About their personal life afterwards?

We meet with patients almost all the time. After all, prosthetics is a continuous process – some changes or adjustments are constantly needed. But as for their personal lives… To be honest, I don’t like to pry, so I don’t know.

Some might think that people who got “new legs” are happy that they learned to walk due to the prosthesis, but I don’t think that’s the case. As a matter of fact, this is very hard work. It requires tremendous effort to learn to walk again. There is no particular moment when you can say all of a sudden, “Oh, I’ve learnt to walk with a prosthesis”. Just stand up and start walking again – this is impossible. Therefore, the wow effect is extremely rare.

Prepared by: Myroslava Bzikadze, UNIAN