Texas Surgeons Perform Historic Skull and Scalp Transplant

A man whose cancer left him with severe damage to the top of the head has received what his doctors in Texas have described as the first skull and scalp transplant.

James Boysen, a 55-year-old software developer from Austin, received the craniofacial tissue transplant at the same time as a kidney and pancreas transplant at Houston Methodist hospital on May 22 in surgeries that lasted nearly a day.

“For this patient, it means a new lease on life,” said Jesse Selber, a reconstructive plastic surgeon who was the co-leader of the team that performed the intricate surgery. “He had series of cancers of the scalp and skull that were treated with various surgeries and radiation that left him with a large wound that was all the way down to his brain.”

A photo of Boysen after the surgery shows him with sutures in a ring around the top of his head, about an inch (2.5cm) above his ears, where the transplanted skull and scalp were attached.

Boysen had already had kidney and pancreas transplants, and those organs were failing. The surgeons conducted all the transplants at the same time using the same donor because it offered the best chance of preventing organ and tissue rejection.

“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,” Boysen said.

He was released from the hospital on June 4y and will spend the next few weeks at a residence used by those recovering from transplant surgery.

Co-ordinating the transplants and planning the surgeries took more than two years. More than 50 healthcare professionals were involved including microsurgeons, neurosurgeons and reconstructive surgeons, said the MD Anderson Cancer Center.

In a 15-hour operation by about a dozen doctors and 40 other health workers, 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. It ends an inch above one ear and two inches above the other.

“This was a very complex surgery because we had to transplant the tissues utilizing 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.