World first scalp, skull transplant comes with new hair

A 55-YEAR-OLD software developer has new hair,  a new scalp and skull - following world first surgery which also included a kidney and pancreas transplant.

James Boysen, from Austin, received the craniofacial tissue transplant at Houston Methodist Hospital on May 22 in surgeries that lasted nearly a day.

"This has been a long journey, and I am so grateful to all the doctors who performed my transplants," Boysen said.

"I'm amazed at how great I feel 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."

The 15-hour surgery, which was conceptualised nearly four years ago, was performed at Houston Methodist Hospital by a team led by MD Anderson's Jesse C. Selber, M.D., and Houston Methodist's A. Osama Gaber, M.D., about 20 hours after LifeGift alerted the team to the availability of the organs.

More than 50 health care professionals performed, assisted with or supported the surgery, including specialised reconstructive plastic surgeons from MD Anderson and Houston Methodist Hospital and a team of transplant surgeons, a neurosurgeon and an anesthesiologist, nurses and others from Houston Methodist.

"This was a very complex surgery because we had to transplant the tissues utilising microsurgery," said Michael Klebuc, M.D., the surgeon who led the Houston Methodist Hospital Plastic Surgery Team.

"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."

In 2006, Boysen had been diagnosed with leiomyosarcoma, a rare cancer of the smooth muscle, on his scalp.

Successfully treated with chemotherapy and radiation, he was left with a large, deep wound on his head that included the scalp and the full thickness of his skull down to his brain.

In addition to the wound, which would require a major reconstructive undertaking, Boysen's kidney and pancreas, which were first transplanted in 1992, were failing.

Diagnosed with diabetes at age 5, Boysen's declining condition over the years prompted the original double-organ transplant.

When Selber and Boysen first met, the scalp and skull wound were preventing doctors from performing the second solid-organ transplant.

Likewise, his critical kidney and pancreas functions, together with his immunosuppression medications, were complicating scalp reconstruction.

But while his wound, medication and transplanted organ failure created a clinical Catch-22, they would also be part of the solution that led to the triple transplant.

"When I first met Jim, I made the connection between him needing a new kidney and pancreas and the ongoing anti-rejection medication to support them, and receiving a full scalp and skull transplant at the same time that would be protected by those same medications," said Selber.

"This was a truly unique clinical situation that created the opportunity to perform this complex transplant."

Dr Klebuc told ABC Radio that Mr Boysen was a little bit overwhelmed when he first woke up but was "really pleased" with the transplant.

"He was actually joking with us today about trying to help him select a type of hair gel that he should use in the future," he said.

"Even now he's showing some early sensation which is quite extraordinary. The other thing that's interesting is that you can actually see him perspire on the scalp now that it's been transplanted."

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