myocutaneous flaps for large, full-thickness cheek defect reconstruc-tion following ablative oral cancer surgery.

Methods: A retrospective review of data from consecutive casesrequiring extensive pedicled supraclavicular fasciocutaneous islandflaps (SFIFs) and the extended vertical lower trapezius island myocu-taneous flap (TIMF) to provide both an inner and an outer lining formajor full-thickness cheek defects following oncological resectionstaking place.

Results: Eight patients had advanced oral SCC. All patients hadcombined bone and extensive soft-tissue defects. The extensive ped-icled SFIF with a skin paddle measuring between 108 cm and1410 cm and the extended vertical lower TIMF with a skin paddlemeasuring 2510–158 cm were used to reconstruct the majorthrough-and-through defects. There was no major complication inany patient. The patients were followed-up for 6–20 months; six pa-tients were living with no evidence of disease, one was living withdisease, and one died of local recurrence.

Conclusions: The combined use of the extensive pedicled SFIFwith an extended vertical lower TIMF to reconstruct major through-and-through cheek soft defects is reliable, and is an excellent alterna-tive to other pedicles, even microsurgical free flaps, for a patient whohas previously undergone radiation and surgery of the head and neck.

doi:10.1016/j.oraloncology.2011.06.440

P198. Ameloblastoma: An experience with different treatmentmodalities in Eastern NepalA. Sagtani*, D. Sybil, A. Bhochhibhoya, A. Rathi

B.P. Koirala Institute of Health Sciences, Nepal

Introduction: Ameloblastoma is a benign but locally malignanttumor of oral cavity. Ameloblastoma usually occurs in persons be-tween the age of 20 and 50 years. Currently, wide resection andimmediate reconstruction is the treatment of choice in most casesof mandibular ameloblastoma. We present our experience in themanagement of this disease.

Methods: Four cases of ameloblastoma were treated from March2008 to March 2010. The lesions were managed by surgical resectionwith a clearance margin of over 1 cm. Three different methods ofreconstruction were used. The first case is of a 30-yr-old lady withameloblastoma in left body of mandible. She was treated by a segmen-tal resection of mandible and immediate reconstruction using a defectbridging plate (DBP). The second case is of a 17-yr-old female withameloblastoma in right mandible and was treated with hemimandib-ulectomy followed by reconstruction using free fibula graft. Two othercases (a 20-yr-old female and an 18-yr-old male) were treated withhemimandibulectomy without any surgical reconstruction.

Results: Esthetic deformity with deviation during mouth openingwas observed in all cases except where free fibula was used forreconstruction. Implant exposure occurred after a period of 1 yearin the case where DBP was used. No recurrence has been noted inany of the cases.

Discussion: Since ameloblastoma is a locally invasive anddestructive tumor, the only rational treatment is radical surgical re-moval with atleast 1 cm of clearance margin. As esthetics is of primeimportance in the maxillofacial region, an immediate reconstructionis preferred. A free specialized graft replacing the lost hard and softtissues is the best reconstructive modality. However, economic sta-tus and health of patient and surgical skills available can lead tocompromised treatment in terms of reconstruction.

doi:10.1016/j.oraloncology.2011.06.441

P199. Single perforator based anterolateral thigh flap for recon-struction of complex oral cavity defectsV. Kekatpure*, N. Trivedi, G. Shetkar, M. Mohan, B. Manjula,M. Kuriakose

Mazumdar-Shaw Cancer Center, Narayana Hrudayalaya, India

Aim: Oral Cancer is a major health problem world wide. Ablativesurgery for oral cancer results in large soft tissue defect which aredifficult to reconstruct. Anterolateral thigh flap provides large andpliable tissue for reconstruction of these defects. However, widevariations in the vascular anatomy of flap are reported. The aim ofthis study was to evaluate the reliability of single perforator basedlarge anterolateral thigh for reconstruction of complex oral cavitydefects following ablative surgery.

Patients and methods: A search of the database maintainedwithin the Department of head and neck surgery at Mazumdar-Shaw Cancer Center identified 25 patients who underwentreconstruction of oral cavity defects with anterolateral thigh flapbased on single perforator between August 2009 and August2010.

Result: The mean flap dimension was 261 cm [2] (range 80–540 cm). In 21 patients the flap was bipaddled and used for innerand outer lining for cheek. None of the flaps were lost due toperforator/vascular insufficiency. There was total failure of twoflaps due to delayed neck wound sepsis after seven post operativeday.

Conclusion: This study establishes safety and reliability of usinga large and/or bipaddled anterolateral thigh flap based on single per-forator for reconstruction of complex oral cavity defects.

doi:10.1016/j.oraloncology.2011.06.442

P200. Revascularisation and rejuvenation of the irradiated neckby autologous lipo-aspirateC. Liew*, S. Cotrufo, N. Kalavrezos

University College London Hospitals, UK

Objectives: In oncology, irradiation of the neck especially aftersurgery may result in considerable morbidity and dysfunction. Thetissues tend to have an unhealthy appearance and patina, and de-velop a board like consistency. Skin and deep tissues fuse to pro-duce tight and unsightly bands. This may result in fixed posturedeformities and considerably restrict cervical and shoulder move-ments, causing pain and discomfort. This and the visual stigmamay significantly affect quality of life and adds to psychologicalmorbidity.

Autologous fat transplantation by injection may in simplisticterms provide a lubricating interface between tissues but may alsobe adapted for use as a filler to address contour discrepancies orprepared to increase delivery of pluripotent mesenchymal adiposederived stem cells. These cells may enhance angiogenesis andrevascularise, regenerate and rejuvenate ischaemic irradiatedtissues.

This is a pilot project in the head and neck, and this presentationdescribes the therapeutic potential of this technique.

Material and method: Patients were initially selected on twocritical criteria – self reported dissatisfaction and dysfunction, anda disease free interval of more than 5 years. All patients were re-quired to have standardised photographs, posture and mobilityassessment, to complete the Visual Analogue Pain Score, the Con-stant–Murley Shoulder Questionnaire and a relevant Quality of Lifedomain. Objective evaluation of tissue quality was assessed using

S138 Abstracts / Oral Oncology 47 (2011) S74–S156