MD Anderson, Methodist doctors gave Jim Boysen a new scalp in 15-hour surgery.
Doctors from MD Anderson, Methodist give man a new scalp in 15-hour surgery
After four years of planning, Dr. Jesse Selber finally got the call he’d been waiting for. His team of more than 60 Houston medical professionals, completing their first-ever skull and scalp transplant, had a donor. No one could believe it. “I was up all night coordinating,” said Selber, a reconstructive plastic surgeon at MD Anderson Cancer Center. “I got 50 phone calls from people saying ‘Are you sure? Are you sure?’ ”
Jim Boysen, the recipient, also had been waiting for a while. He first met Selber at the cancer center in 2011. Boysen, who has Type 1 diabetes, had spent a lifetime in and out of the hospital. He had his first kidney and pancreas transplant at age 32, having gone on dialysis two years earlier.
Boysen developed cancer on the top of his head from immunosuppressant drugs he was taking to prevent the rejection of his kidney and pancreas transplant about 20 years prior. The radiation from his cancer treatment left an open wound on top of his head.
He traveled to MD Anderson to fix the wound, and his reconstructive surgeon introduced him to Selber.
The meeting would change Boysen’s life.
He needed both a kidney transplant and a pancreas transplant because both organs were going into failure, but he couldn’t have the surgery with an open wound on his head. Selber asked Boysen if he would be interested in having skin surgically transplanted to his skull.
“He had a lot of problems going on at the same time,” Selber said. “It’s a dream to be able to transplant every part that you need from one magical donor somewhere. No one has ever done that before.”
Selber, who had been researching face transplants, thought the best solution would be one surgery in which the skull, scalp, pancreas and kidney were transplanted at the same time. Selber believed the surgery was possible, but he was more worried about the planning involved.
“How do we coordinate this across multiple hospitals, across an organ donor group, across a donor hospital?” he remembers asking himself. “There was a lot of work to be done to get this teed up. I just started plugging away.”
Before the 15-hour surgery took place in May 2015 at Houston Methodist Hospital, Selber began assembling a team of four surgeons who typically do head or neck surgeries.
Dr. Osama Gaber, director of the J.C. Walter Transplant Center at Houston Methodist, also had work to do. He began coordinating his team of medical professionals to assist on the kidney and pancreas transplant.
“We thought we could work simultaneously,” Gaber said. “The idea was to get the organs in as soon as possible.”
Selber’s team practiced the skull and scalp transplants on cadavers, which made it easier to work on the difficult tissue transfers.
“More than anything before the surgery, I felt responsible for Jim and for making sure that all of this happened for him,” Selber said. “Every day and every month that passed that we didn’t do this was another day, month, and even year that Jim had to get by with his existing scenario, which is organ failure.”
In the meantime, Boysen waited for a suitable donor. Gaber said “it wasn’t easy” finding one, especially for the skull and scalp transplants. They needed to find a match in skin color, tone and head shape.
“When you feel that bad, it’s kind of like, ‘Well let’s do this and get this done,’ ” Boysen recalled. The waiting took its toll on the surgeon as well.
“This is like having the Super Bowl but never knowing what day it’s going to happen,” Selber said. “Then all of a sudden just having to play the game.”
The day of the surgery, Selber’s team traveled to UT Medical Center to retrieve the organs from the donor for Boysen.
The skull and scalp receives its blood supply from the vessels that run up in front of both ears, according to Selber. His medical team had only two hours to connect the new blood vessel tissue, which meant retrieving the donor organs from UT Medical Center, transporting them to Houston Methodist, and then connecting the tissue in the operating room at Methodist.
At Houston Methodist, the team, unfamiliar with the operating rooms, searched frantically for them. “I got this
box with the ice and the scalp and skull in it, and we’re wandering down hallways, looking for the operating room,” Selber recalled.
His team was unsure if the skull and scalp needed blood supply from both vessels, so they planned to hook up both sides.
“If we cut off the top of Jim’s head and we couldn’t get this to work for some reason, then you’re in real trouble,” Selber said. “That was kind of a backup way of minimizing the risk of the operation.”
The medical team expected to have both sides of blood vessels connect potentially, but because the donor had suffered a gunshot wound on one side, they could rely on only one.
“Having the backup plan removed was an extra level of anxiety,” Selber said. “Instead of taking Jim’s entire skull and scalp off and seeing if the whole thing worked, we did the blood vessel connection to the new scalp and skull and left it off to the side with its new plumbing and made sure that it worked.”
Selber’s team met its two-hour time limit for connecting the new blood vessel tissue, then spent several hours completing the skull and scalp transplant, finishing up around 4 a.m.
Then Gaber’s team began its phase. He realized they wouldn’t be able to work side by side after observing the small room and the tediousness of the scalp/skull transplant.
“We had practiced so much and talked about it so much that as we did it, we recognized that we are actually doing everything that we said we were going to do,” Gaber said. The surgery was a success. More than a year later, Boysen, a software developer who lives in Austin, drives down once a month for a checkup with Selber. He also gets his blood checked every few weeks to make sure his pancreas and kidney are functioning well. His longtime girlfriend, Kay Mouser, stood by him throughout the transplant and during recovery.
Shortly after surgery, it took a while for the swelling to go down on Boysen’s scalp. But now some people can’t even tell that he ever had surgery in the spot.
“It looks pretty good,” said Boysen, who is in his mid-50s. “Better than I thought it would, to tell you the truth.”
Selber remains pleased with the results.
“It’s sort of like sending sheet music to a bunch of different musicians around the world, never having them listen to each other,” Selber said. “Not knowing what the composition is supposed to sound like, and having them come together one day and play it perfectly.”