A HERO IN BURN THERAPY
Some time ago, a friend referred me to a
Medscape list of the “Fifty Most Influential Physicians in History”. Many names
on the list are familiar to physicians and medical historians, but one
unfamiliar name caught my attention: Dr. Zora Janzekovic. She was noted to be a
plastic surgeon from Slovenia, elevated into this group of fifty for her major
contributions to the therapy of burns. Her achievement is especially remarkable
considering the demanding conditions under which she worked.
Dr. Janzekovic was born in September,
1918, in Slovenska
Bistrica, Slovenia. After receiving her MD degree at the Zagreb
University Medical School, she obtained specialty training in plastic surgery
in Belgrade, then underwent a rapid, six-month training course in burn management
in Ljubljana, Slovenia. Enough scientific exchange with the West existed, however, to ensure good training. She was assigned to run a burn unit in the city of
Maribor, the second-largest city in Slovenia, situated in the northeast, where
burns, especially in children, were frequent.
On arrival, Janzekovic was greeted with
almost impossible conditions. Yugoslavia was still behind the Iron Curtain and
the Cold War was on. In the Maribor hospital she found that no burn unit
existed. Surgical equipment, food, dressings, and medications were all scarce
or absent and there was limited access to pertinent literature. Nurses and physicians
had not been trained to care for burn victims, and funds to remedy conditions
were meager. Children with burns came frequently, and Dr. Janzekovic was pained
to witness their emaciation and suffering.
 |
| Dr. Zora Janzekovic (Wikipedia) |
Janzekovic commandeered yet more hospital
space. Equally important, she realized that the infections under the dressings
were coming from the patients’ own tissues, allowing her to cut down on
isolation procedures, saving time and space. She trained the nurses and
acquired another physician to help.
The major breakthrough came next. At the
time, the usual practice with deep burns was to protect the burn with dressings
until the superficial dead tissue demarcated from the healthier tissues beneath, then apply
skin grafts. This took time, and Janzekovic wondered if one could shorten the
process by simply excising the upper, apparently dead, layers of tissue only a
few days after the burn and then apply grafts immediately to the denuded area. Pushed by
the sheer number of patients, she tried the new approach on a few smaller
burns, with success. With more experience, she honed the technique and calibrated
the best timing for excisions and dressing changes. Happily, the early grafts healed
more rapidly and with a minimum of scarring. Gradually she tackled larger and
larger burns, many large enough to require skin grafts from other donors. Overall
the new procedure saved huge amounts of time, freed up needed beds, and reduced
the infection rate dramatically, saving the use of scarce antibiotics.
Soon her colleagues from the capital,
Ljubljana, came to Maribor to see for themselves, and were impressed enough to
invite others from abroad. In 1968 the Burns Society of Slovenia held the Third
Congress of the Yugoslav Association for Plastic and Maxillofacial Surgery in
Maribor. A number of burn specialists attended, among them Douglas Jackson,
from England, who tried out the method in his home city of Birmingham. Dr.
Jackson, named, in 1969, to give the first Everett Idris Evans Memorial Lecture
(named after the surgeon who pioneered research on fluid dynamics in burns and
on radiation burns), pronounced the method successful. His opinion brushed away
a good deal of skepticism and the Janzekovic method spread.
In 1975 Janzekovic published her
experience with an astounding 2,615 patients who had undergone the excision and
grafting procedure. Pain was reduced, patients discharged more promptly
(average stay was 14 days), aesthetic appearance improved, and contractures from
scarring were relatively infrequent.
By this time Dr. Janzekovic was well known.
Between 1968 and 1984 a total of 237 burn surgeons made a pilgrimage to her
clinic, and she was invited to lecture at meetings “from Los Angeles to
Shanghai,” as she put it. She was chosen, in 1975, to deliver the Evans
Memorial Lecture, the same lecture at which Douglas Jackson had first publicized
her technique. In 2007 a new award was created by the European Club for Pediatric Burns, the Zora Janzekovic Award: “The
Golden Razor”. Dr. Janzekovic was, of course, the first recipient and she received many other honors.Today her technique is standard practice in burn therapy.
In her later years Dr. Janzekovic did
research on shock in burns, though, as she said, “it was far too great a
challenge for our circumstances.” She did, however, think that overheated blood
might produce toxins and speculated on the use of exchange transfusions to eliminate
them.
Zora Janzekovic, after many years of tireless
work and healing thousands of children, retired in her native country. She had lived through WWII, worked throughout the Cold War in communist Yugoslavia, and,
finally, made the transition to the European Union. At
her 90th birthday she was quoted as saying, “My life was worth
having been lived.” She died in 2015 at age 96. It is fitting that she is ranked
in Medscape’s 50 most influential physicians.
SOURCES:
Dr. Igor M Ravnik, in Ljubljana, kindly
reviewed and helped with this essay.
Janzekovic, Z. “Once upon a
time: How west discovered east”. 2008; J Plast Reconstr, Aesthet Surg
61: 240-44.
Burd, A. “Once upon a time
and the timing of surgery in burns”. 2008; J Plast Reconstr Aesthet Surg
61: 237-9.
Janzekovic, Z. “A new concept
in the early excision and immediate grafting of burns”. 1970; J Trauma
10: 1103-8.
Janzekovic, Z. “The burn wound
from the surgical point of view”. 1975; J Trauma 15: 42-62.
Obituary. 2015; Burns 41:1374.
Barrow, R E and Herndon, D N.
“History of treatments of burns”. Chapter in Herndon, D N, ed. Total Burn
Care, 3rd edit. 2007; pp 1-8.
Powers, J M and Feldman, M J.
“Everett Evans, nuclear war, and the birth of the civilian burn center”. 2017;
Amer Coll Surg Poster Competition.
