Clinical epidemiology, microbiology, and care of war-related wounds in Ukraine.

BACKGROUND: Since Russia's full-scale invasion of Ukraine in 2022, casualties have frequently sustained extensive soft tissue injury and contamination requiring complex wound care and prolonged hospitalization. To characterize in-country care, we conducted a retrospective case series of adult patients with conflict-related traumatic wounds to describe wound characteristics, microbiologic testing, antibiotic use, and resistance patterns during active conflict in Ukraine. METHODS: We conducted a retrospective case series to identify a consecutive population of adult patients treated at a single, referral hospital in western Ukraine for wounds management. Structured medical record abstraction was performed. The primary outcome was prevalence of complex traumatic wounds. Secondary outcomes included prevalence of antibiotic resistance among cultured wounds, surgical amputation associated with the wound, and length of hospital stay. Descriptive statistics were calculated for all variables. RESULTS: One hundred patients with conflict-related traumatic wounds were included. All were male with injuries occurring on the eastern frontlines from blast-related mechanisms. Median time from injury to hospitalization at study facility was 25.5 days. Overall, 95% of wounds met the case definition of a complex wound, predominantly due to presence of wound necrosis (90%). Wound cultures were obtained in half of patients (51%) with 24% (n=12) showing significant positive bacterial growth. Antibiotic resistance was identified in 9 of the 12 cultures. Nearly all patients received intravenous antibiotics (98%) for a mean duration of 7.3 days. Surgical debridement was performed in 99% of patients, while 2% underwent amputation during hospitalization. Hospital length of stay was a median of 14 days. CONCLUSION: In this cohort of conflict-related traumatic wounds in Ukraine, intravenous antibiotics were used extensively in a manner consistent with cautious, risk-averse combat trauma care. These findings primarily reflect the challenges of clinical decision-making in austere, high-risk environments and underscore the need for supportive, wartime-adapted stewardship frameworks. (J Trauma Acute Care Surg. 2026;000: 000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved). LEVEL OF EVIDENCE: Level V - Case Series / Epidemiological.