The Revolution in Burns Management

Sitting in a box of papers in the BAPRAS Collection’s archive is a draft manuscripts describing a revolution in burn management.

Until the late 1960s potentially deeper burn injuries were left for many days, for it to become clear whether they would heal spontaneously, or require surgical excision and skin graft cover. But a “left field” innovation from a very small unit in the former Yugoslavian region of Slovenia changed that.

A young physician called Zora Janzecovic, with no experience in burns or plastic surgery, was detailed to put together and look after a new burns ward at the small town of Maribor. This was to cope with an overflow of cases in the main plastic surgery unit of Ljubljana. She soon became overwhelmed with cases in the austere, resource and nutritionally poor conditions of the former communist state. Largely forgotten by her superiors in Ljubljana, within six months she had gained some proficiency in managing the burns.

With a shortage of space and beds, it occurred to her that waiting for burns to demarcate into superficial, which would heal, and deep, which would require surgery to heal, was wasting a lot of time. She decided to try to solve this, and also prevent the onset of infection, by attempting early shaved excision of burnt skin whose depth was uncertain.  She used a technique of graded horizontal shaving. By trial and error, she found that grafting of partial depth burns after early graded shaving saved time and improved the results. By February 1961 this had become a routine procedure in Maribor and she felt emboldened to approach her superiors in Ljubljana. Fortunately, they immediately realised that she had achieved something revolutionary. They called in well-known burn surgeons from around the world, including Antony B Wallace and John Barron from Britain.

It took Janzecovic and her team some time and several international presentations demonstrating their technique and results to overcome the scepticism of the international burns community. Between 1968 and 1984, 237 burn surgeons visited Maribor to learn the new technique.

Barron remained very supportive, since he had been instrumental in the instigation of plastic surgery services in the then Jugoslavia at the end of World War 2. He received a draft from Janzecovic, entitled “Excision in Burns”, describing her method and results, for proof reading and editing. Then he was sent a final manuscript. These are preserved in the BAPRAS archive of Barron’s papers.