US doctors have hailed a complex operation as a world first after performing a skull and scalp transplant on a cancer patient who also received a new kidney and pancreas during the procedure.
James Boysen, a 55-year-old software developer, underwent 15 hours of surgery performed with the help of more than 50 medical professionals, the MD Anderson Cancer Center in Houston said.
It said that the historic surgery made Boysen the "first patient to receive the simultaneous craniofacial tissue transplant together with solid organ transplants."
The operation, performed at Houston Methodist Hospital, was conceptualised almost four years ago, but wasn't carried out until May 22, some 20 hours after doctors were told appropriate organs had become available.
"This was a very complex surgery because we had to transplant the tissues utilising microsurgery," said Michael Klebuc, lead surgeon from the Houston Methodist Hospital plastic surgery team that helped perform the skull-scalp transplant.
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"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," he said.
Boysen, a resident of Austin, was diagnosed with leiomyosarcoma, a rare cancer that attacks smooth muscle, on his scalp in 2006.
The cancer was treated successfully but left a large wound on his scalp and skull.
The Texas man, who was also diagnosed with diabetes at age five, had undergone a previous double-organ kidney and pancreas transplant in 1992, but those organs were needing transplanting again.
Because of his skull and scalp wounds, however, that procedure was not possible.
Meanwhile his kidney and pancreas issues and the immunosuppression medications he was on because of them, made scalp reconstruction difficult.
Doctors solved the dilemma by carrying out all procedures at once.
"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 MD Anderson's Jesse Selber, one of the lead surgeons.
"This was a truly unique clinical situation," he said.
