Operation implants partial skull, scalp

Opening a new frontier in transplant surgery, Texas doctors have done the world’s first partial skull and scalp transplant to help a man who suffered a large head wound from cancer treatment.

Doctors from Houston Methodist Hospital and MD Anderson Cancer Center performed the operation two weeks ago.

The recipient — Jim Boysen, a 55- year- old software developer from Austin, Texas — was to leave the hospital Thursday with a new kidney and pancreas along with the scalp and skull grafts. He said he was stunned at how well doctors matched him to a donor with similar skin and hair coloring.

“It’s kind of shocking, really, how good they got it. I will have way more hair than when I was 21,” Boysen joked.

The Texas operation is thought to be the first skullscalp transplant from a human donor, as opposed to an artificial implant or a simple bone graft.

Boysen had a kidney- pancreas transplant in 1992 to treat diabetes he has had since age 5 and has been on drugs to prevent organ rejection. The immune suppression drugs raise the risk of cancer, and he developed a rare type — leiomyosarcoma, which affected the muscles under his scalp.

Radiation therapy for the cancer destroyed part of his head, immune suppression drugs kept his body from repairing the damage, and his transplanted organs were starting to fail — “a perfect storm that made the wound not heal,” Boysen said.

Doctors could not perform a new kidney- pancreas transplant as long as he had an open wound. That’s when Dr. Jesse Selber, a reconstructive plastic surgeon at MD Anderson, thought of giving him a new partial skull and scalp at the same time as the new organs.

Boysen’s wound extended through his skull to his brain, Selber said.

In a 15- hour operation, Boysen was given a cap- shaped, 10- by- 10- inch skull graft, and a 15- inch- wide scalp graft starting above his forehead, extending across the top of his head and over its crown.

Any surgery around the brain is difficult, and this one required delicate work to remove and replace a large part of the skull and re- establish a blood supply to keep the transplant viable.

“We had to connect small blood vessels about one- sixteenth of an inch thick. It’s done under an operating microscope with little stitches about half the thickness of a human hair, using tools like a jeweler would use to make a fine Swiss watch,” said Dr. Michael Klebuc, who led the Houston Methodist plastic surgery team.

The pancreas and kidney were transplanted after the head surgery was done.

Boysen said Thursday at a news conference at Houston Methodist that he already has sensation in the new scalp.

The new scalp also was sweating in the hot room — another surprise so soon after the operation, he said.

He will remain in Houston for two to three weeks for follow- up treatment. He will need to keep his head covered because sunlight increases the chance of rejection, his doctors said.

Over the past decade, transplants once considered impossible have become a reality. More than two dozen face transplants have been done since the first one in France in 2005; the first one in the U. S. was done in Cleveland in 2008.

In addition, more than 70 hand transplants have been done around the world. And, in October, a Swedish woman became the first in the world to give birth after a womb transplant.

Many other patients have received transplants or implants of 3- D printed body parts, ranging from blood vessels to windpipes.