James Boysen is interviewed on his bed at Houston Methodist Hospital in Houston. Texas doctors say he received the world’s first skull and scalp transplant from a human donor to help heal a large head wound from cancer treatment.

Transplant surgery has come a long way. The world’s first face transplant was done in France in 2005. Since then, through the use of 3-D printed body parts, artificial organs and donated ones, complex surgeries once thought to be impossible have been carried out successfully around the world. One such surgery was the skull-scalp transplant in Houston, Texas.

Doctors from the Houston Methodist Hospital and the MD Anderson Cancer Center at the University of Texas performed a 15-hour first partial transplant surgery of the scalp and skull. A collaborative effort between 40 health workers and a dozen doctors, the head surgery was followed by a kidney and pancreas transplant. The total surgery took 24 hours to complete.

James Boysen, a 55-year old software developer from Austin Texas was the recipient. Boysen was diagnosed with diabetes when he was five and in 1992 he had a pancreas-kidney transplant to treat it. Unfortunately the immunosuppressive drugs he had to take raised the risk of contracting cancer. He contracted a rare form of cancer in 2006, leiomyosarcoma.

This cancer affects several kinds of smooth muscles. In Boysen’s case, the muscles were the ones under his scalp, which make the hair stand on end when you get goosebumps.

When given radiation therapy, a part of his head measuring 10X10 inches was damaged and formed a deep wound, which the immune-suppressive drugs prevented from being repaired. To add to the danger, his transplanted organs started to fail. The doctors couldn’t perform transplant surgery without dealing with the open head wound.

“I couldn’t get the transplant surgery required for the organs because of the wound in my scalp due to it being an open wound but I couldn’t get it fixed because of the failing organs. It was a Catch-22, I was between a rock and hard place.” Boysen said.

Dr Jesse C Selber, associate professor of plastic and reconstructive surgery at MD Anderson, came up with the solution four years ago: to give Boysen a new skull and scalp simultaneously as the new organs. It took LifeGift, an organ procurement organization in Texas, 18 months to find all the organs from the right donor.

The surgery went underway on May 22, 2015, 20 hours after LifeGift gave the confirmation of availability of required organs.

Dr Michael Klebuc, who led the Houston Methodist Hospital plastic surgery team, explained the complex surgery that utilized transplanting tissues with microsurgery, “We had to connect small blood vessels a one-sixteenth of an inch thick under the operating microscope. The stitches had about half the thickness of a human hair and we used fine tools used to make a Swiss watch.”

The highly complex operation went successfully.

Boysen told Associated Press, “It’s shocking, really, how good they got it. I will have more hair than I was 21.” He now has a 15-inch skull graft, which ends 2 inches above one ear and 1 inch above the other. Doctors said to keep it covered as sun exposure can increase the chance of tissue rejection. The skull graft is considered to be the first skull-scalp transplant from a human donor. In the Netherlands, last year, a woman’s skull was replaced by a 3-D printed artificial one.