History of Medicine

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)

    But she forged ahead. She managed to acquire three rooms in the dermatology department, gradually expanding to accommodate the approximately 350 burn patients seen per year, many of them serious, and most needing painstaking care. Dressings full of pus piled up after the daily changes, creating a repugnant stench, and medications were in short supply. The staff was buckling from overwork.

     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 90^th 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, 3^rd 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.