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In modern armed conflicts, civilians carry a significant amount of burden not only as they have increasingly become strategic targets resulting in severe physical injuries. The aim of this study was to provide insight into epidemiology and trauma characteristics of Ukrainian civilians transferred to Austrian trauma centers for further medical care.

Data of Ukrainian civilians injured during the first three years of the conflict was obtained from the Austrian Federal Ministry of the Interior. This included general demographic parameters,
type and distribution of injuries and time between injury and admission to Austria. Injury
severity score (ISS) was calculated and a value above 16 was considered as polytrauma. Data was compared statistically between the three years. A p-value < 0.05 was considered statistically significant.

91 civilians (58% women) with a mean age of 38.3 (SD 16.9) years have been transferred to Austria. The lower extremity was most commonly affected (n=59, 65%), followed by the upper extremity (n=33, 36%), the face and neck (n=31, 34%), the abdomen and pelvis (n=25, 27%), the chest (n=18, 20%), the cranium (n=17, 19%), and the spine (n=9, 10%). Mean ISS was 29.3 (SD 11.6) and 90 fulfilled the criteria for polytrauma. Transfer times were significantly longer (p=0.010) and ISS was significantly lower (p=0.001) during the first year of the conflict.

Ukrainian civilians are heavily affected by the war with significant injury burden and comparably high mean ISS. Shorter transfer times were noted throughout the conflict indicating establishing routine in patient evaluation and management.

Multidrug-resistant pathogens are an increasingly serious challenge in surgical and intensive care. Plastic and reconstructive surgery centres in particular, especially those treating patients from countries with high antimicrobial resistance rates such as Romania and Ukraine, are confronted with a complex microbial spectrum. The ongoing war in Ukraine has led to a rising number of infected combat-related injuries with complex soft-tissue and bony defects, as well as severe burn injuries associated with a high burden of Multidrug-resistant pathogens.

A narrative review of the literature on Multidrug-resistant infections in surgical and plastic-reconstructive care was conducted. Clinical experience from a German university centre was combined with current epidemiological data from Ukraine. Selected cases were used to illustrate typical pathogen profiles, therapeutic strategies, and organisational challenges.

Recent studies indicate a substantial increase in antimicrobial resistance in Ukraine. High rates of Multidrug-resistant pathogens have been reported in war-injured patients, considerably complicating treatment. The most frequently encountered pathogens include Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae. In selected cases, particularly in patients originating from Ukraine, tuberculosis—including multidrug-resistant strains—must also be considered as a potential nosocomial threat. Successful treatment generally relies on repeated surgical debridement, close interdisciplinary collaboration, and strict infection control measures.

The management of foreign patients with Multidrug-resistant infections and complex injury patterns requires a high degree of flexibility, interdisciplinary expertise, and up-to-date infection prevention strategies. The integration of current international evidence highlights the need for standardized European treatment and transfer protocols in order to improve clinical outcomes sustainably.