A 55-year-old man from Austin, TX, has become the first person to undergo a partial skull and scalp transplant, performed simultaneously alongside kidney and pancreas transplants.
A 50-strong team led by Dr. Jesse C. Selber, of the MD Anderson Cancer Center at the University of Texas, and Dr. A. Osama Gaber, of the Houston Methodist Hospital, TX, performed the complex surgery, which took 24 hours to complete in total.
Software developer James Boysen was diagnosed with leiomyosarcoma - a rare cancer of the smooth muscle tissue - on his scalp in 2006.
Though Boysen underwent successful chemotherapy and radiotherapy for the cancer, the treatment severely damaged his scalp tissue, leaving a 10-by-10-inch wound that descended through the skull to the brain.
Boysen's kidney and pancreas were also found to be failing. Both of these organs were first transplanted in 1992 as a result of damage caused by diabetes, which he had been diagnosed with at the age of 5.
As a result, Boysen required reconstructive surgery on his scalp, as well as kidney and pancreas transplants. This presented a challenge for surgeons; the skull and scalp wound were stopping them from performing the kidney and pancreas transplants, while Boysen's organ failures and the immunosuppressive medications he was taking posed difficulties for scalp reconstruction.
However, Dr. Selber came up with a novel idea 4 years ago that would allow all the required surgery to go ahead.
"When I first met Jim, I made the connection between him needing a new kidney and pancreas and the ongoing antirejection medication to support them, and receiving a full scalp and skull transplant at the same time that would be protected by those same medications," Dr. Selber explains.
"This was a truly unique clinical situation that created the opportunity to perform this complex transplant."
Transplantation required complex microsurgery
Boysen underwent the surgery on May 22nd, around 20 hours after LifeGift - the designated organ procurement organization for North, Southeast and West Texas - notified surgeons to the availability of a donor kidney and pancreas, as well as a skull and scalp with similar skin and hair coloring.
Dr. Michael Klebuc, who led the plastic surgery team at Houston Methodist Hospital during the surgery, notes the difficulties of performing the procedure.
"This was a very complex surgery because we had to transplant the tissues utilizing microsurgery," he says. "Imagine connecting blood vessels 1/16 of an inch under a microscope with tiny stitches about half the diameter of a human hair being done with tools that one would use to make a fine Swiss watch."
The surgeons explain the procedure further in the video below:
Despite its complexity, the procedure was a success. Boysen now has a 15-inch-wide scalp graft that ends 1 inch above one ear and 2 inches above the other, and he is amazed by the results.
"It's kind of shocking, really, how good they got it," Boysen told the Associated Press. "I will have way more hair than when I was 21."
Commenting on the surgery's outcomes, Dr. Selber says:
"While it was incredibly exciting to bring together two of the Texas Medical Center's leading institutions to collaborate and leverage their expertise for this first-ever transplant, the most meaningful result is what the successful surgery will mean for Jim.
This was an ideal clinical situation that allowed us to transplant all these tissues from one patient, and Jim's patience, courage and enthusiasm for the idea were vital."
Boysen - who was discharged from Houston Methodist Hospital yesterday - says he is "so grateful" to all of the surgeons who performed his transplant.
"I'm amazed at how great I feel," he adds, "and am forever grateful that I have another chance to get back to doing the things I love and be with the people I love."
In April, Medical News Today reported on a 30-year-old Russian man who has volunteered to undergo the world's first human head transplant within the next 2 years.