S479 FACIAL ARTERY MYOMUCOSAL FLAP FOR RECONSTRUCTION OF PARTIAL GLOSSECTOMY DEFECTS Kristen Aliano, MD, Jessica Korsh, MS, Katelin O'Brien, Matthew Kilgo, MD, Tomasso Addona, MD, Benjamin Saltman, MD, Thomas Davenport, MD, Douglas K Frank, MD; Divisions of Head and Neck Surgery and Plastic and Reconstructive Surgery, Long Island Jewish Medical Center, New Hyde Park, NY; Long Island Plastic Surgery Group, Garden City, NY; New York Head and Neck Institute, North Shore-LIJ Health System Background: Tongue reconstruction after cancer surgery must maintain functions of mastication, speech, and deglutition. Small defects of the oral tongue are closed primarily or with skin grafts. Medium-sized defects (up to one third or a bit larger) are closed with skin grafts or free tissue transfer. As an alternative to skin grafting and primary closure, we began using the facial artery myomucosal flap (FAMM), a local buccal flap based on the facial artery, for reconstruction of those small oral tongue and floor of mouth defects (resulting from carcinoma excision) where the former techniques were anticipated to result in tissue tethering and functional impairment. We have also been utilizing the FAMM for reconstruction of larger (medium-sized) oral tongue and floor of mouth defects where use of free tissue transfer to ensure good functional outcome could be regarded as excessive. We present our early experience with use of the FAMM to reconstruct small and medium-sized defects of the oral tongue after carcinoma excision. The use of the FAMM for reconstruction of defects resulting from excision of carcinomas epicentered in the floor of mouth will be reported separately. Methods: Hospital and office records of patients who had a FAMM to reconstruct the oral tongue after cancer excision at our center were reviewed. Pertinent outcome parameters were assessed. The University of Michigan Voice-Related Quality of Life and the MD Anderson Dysphagia Inventories were mailed to surviving patients. Results: Twenty-one patients underwent FAMM reconstruction for partial oral glossectomy defects. The floor of mouth was involved by direct tumor extension in 9 patients, but came to be involved after tumor extirpation in all patients. All patients had immediate reconstruction. The average patient follow-up was 130 weeks. All flaps survived. The average length of stay was 7.9 days (all patients have a temporary trachestomy placed and are NPO for the first 5-7 post-op days), not including 2 patients who had extended stay due to medical co-morbidity. All patients were dischared decannulated, tolerating soft diet. The time for reconstruction ranged from 59m (approximates current experience) to 3hr, 1m (earliest experience). The majority of the patients were found subjectively to have intelligible speech, good tongue mobility, no difficulty with mastication, and good swallowing ability at discharge and in follow-up.

Eight of 18 surviving patients returned the dysphagia and voice-related quality of life surveys. No patients reported having job difficulty because of their speech, 6 reported having no difficulty using the phone, and 7 respondents stated that they have not become less social because of their speech. Seven of 8 respondents reported that quality of voice was good, very good, or excellent. No patients felt excluded from others because of eating habits, and 6 respondents stated that they did not have to limit food intake. Conclusion: The FAMM is an excellent reconstructive alternative to skin grafting, primary closure, and free tissue transfer in appropriately selected oral tongue cancer patients. There is minimal donor site morbidity, and functional outcomes seem to be acceptable based on subjective and limited objective data.

S480 MEDIAL SURAL ARTERY PERFORATOR FLAPS IN INTRA-ORAL HEAD & NECK RECONSTRUCTION: THE NEWCASTLE EXPERIENCE. Iain B Anderson, BSc, MBBS, Kazi M Rahman, Mr, Stephanie Young, Miss, Richard Chalmers, Mr, Kristian Sorensen, Mr, Michael D Kernohan, Mr, Omar A Ahmed, Mr, Maniram Ragbir, Mr; The Royal Victoria Infirmary, Newcastle upon Tyne, UK Introduction and Aims: Various fasciocutaneous flaps have been used in intra-oral reconstruction for head and neck cancer. The radial forearm and anterolateral thigh flaps are the workhorse flaps in this field. However, the radial forearm flap has a poor donor site whilst the anterolateral thigh flap is often a bulky flap in the western population. In an attempt to find a more ideal alternative, we present our initial experience using the Medial Sural Artery Perforator (MSAP) flap in intra-oral reconstruction. This is a thin, pliable flap with a lengthy reliable pedicle. Methods: All head and neck oncology patients present to a multi-disciplinary clinic. Patients requiring intra-oral soft tissue reconstruction have a detailed consultation including discussion of available reconstructive options including an MSAP flap. In the last year, 7 patients underwent a free MSAP flap reconstruction of an intra-oral soft tissue defect following cancer resection. Operative and outcome data was collected prospectively into our Free Flap Database. Results: Seven patients (3 female, 4 male) with age ranges between 47 and 79 underwent resection of an intraoral squamous cell carcinoma which were all reconstructed using a free fasciocutaneous MSAP flap. The average flap dimensions were 12x5x0.6cm. The average pedicle length was 12cm with an artery diameter of 2mm and a vein diameter of 3.5mm. All flaps survived with no returns to theatre. All donor sites were closed primarily. There was one donor site dehiscence in our first case managed nonoperatively. Conclusion: We are the first UK unit to report on MSAP flaps for intra-oral reconstruction. We have found this flap to be a reliable alternative to our traditional options. The MSAP flap provides thin pliable skin similar to a radial forearm flap with a reliable and lengthy vascular pedicle. A two-team approach can be adopted with tumour resection and flap raising occurring simultaneously. By closing the donor site directly, a discrete and acceptable scar is located in on the calf.

S481 TECHNICAL FACTORS THAT AFFECT ANASTOMOTIC INTEGRITY IN SKIN FLAP PHARYNGOESOPHAGEAL RECONSTRUCTION FOR HYPOPHARYNGEAL CANCER: A SINGLE INSTITUTE EXPERIENCE Chao-Ming Wu, MD, Kai-Ping Chang, MD, PhD, Hung-Chi Chen, MD, Chung-Kan Tsao, MD, Huang-Kai Kao, MD; 1. Department of Plastic Surgery, Chang Gung Memorial Hospital, Linkuo, 2.Department of Otolaryngology, Chang Gung Memorial Hospital, Linkuo Background. Due to the significant contribution of anastomotic leak in pharyngoesophageal reconstruction for hypopharyngeal cancer patients following cancer resection, with its disastrous consequences to patients' morbidity and mortality, the purpose of this retrospective study was to examine the main technical parameters that impact on anastomotic integrity. Methods. Between July of 1993 and May of 2010, 84 patients (82 men and two women) underwent pharyngoesophageal reconstruction after tumor ablation in Chang Gung Memorial Hospital-Linkou Medical Center. Patients' age ranged from 36 to 81 years (mean, 50.5 years). Technical factors evaluated included radial forearm flap versus anterolateral thigh flap, fasciocutaneous type of anterolateral thigh flap versus chimeric type of anterolateral thigh flap, and circumferential versus near-circumferential defect. The outcome of interest is the incidence of anastomosis leak. Results.The free radial forearm flap was used in 35 cases. The free anterolateral thigh flap was used in 49 cases, with a fasciocutaneous type in 22 patients and a chimeric type in 27 patients. The radial forearm group had a significantly higher rate of anastomosis leak than the anterolateral thigh group (54.3% vs. 30.6%, p=0.042). No significant difference in the incidence of anastomosis leak was demonstrated between the fasciocutaneous type and chimeric type of anterolateral thigh flap. Patients with circumferential defects had a higher rate of leak than those with near-circumferential defects (44.6% vs. 10%, p=0.04). Conclusions. The rate of anastomosis leak in pharyngoesopharyngeal reconstruction is affected by reconstruction option and defect type. Anterolateral thigh flap appears to be considered a viable option for hypopharyngeal reconstruction. The more technical demand with the anterolateral thigh flap must be weighed against an easily harvested radial forearm flap.

S482 PREFERENCES IN PHARYNGOESOPHAGEAL RECONSTRUCTION, THE RESULTS OF A SURVEY OF THE AMERICAN HEAD AND NECK SOCIETY MEMBERSHIP P Kesarwani, MD, R Zaveri, MD, S Byrd, K Lees, BA, R Walker, MD, M Varvares; The Departments of Otolaryngology, Head and Neck Surgery at the University of Rochester School of Medicine, Univeristy of Illinois School of Medicine and the Saint Louis University School of Medicine Background: Reconstruction of the pharyngoesophagus continues to be a challenge for both patients and head and neck surgeons, without the emergence of a clearly superior technique that results in the best combined functional recovery and lowest perioperative mortality and morbidity. To help clarify what the most frequently utilized donor sites are and the reasons surgeons choose their preferred sites in the reconstruction of the pharyngoesophageal segment, the membership of the American Head and Neck Society (AHNS) was surveyed. Methods: A cross sectional designed survey that queried the AHNS membership as to their preferred methods of reconstruction of pharyngoesophageal defects, practice setting, the reasons behind choosing their preferred donor sites as well as additional information regarding use of salivary bypass tubes and postoperative barium swallows was developed. Survey Monkey was used to administer the survey; responses were collected between March to May of 2012. Descriptive statistics for responses were obtained using Microsoft Excel. Results: 889 surveys were sent and 124 were completed in total and returned, with an overall response rate of 12.8 %. Nearly all responses were from North America. Seventy seven percent of respondents were practicing in full time academic positions. Respondents indicated that the preferred choice for non-circumferential defects was the radial forearm free flap (n = 64), the pectoralis myocutaneous flap (n=44) and the anterolateral thigh flap (n=16) and reported a total of 1,606 procedures for the year preceding the survey. For circumferential defects the radial forearm free flap was the most common response (n= 50) followed by the anterolateral thigh (n= 34) and the jejunal flap (n=18) and a total of 874 procedures were reported for the year preceding the survey. The most commonly reported factors for donor site selection included ease of the procedure, the procedure that results in the lowest perioperative morbidity and mortality, the lowest risk of stricture or fistula and the most reliable technique to result in resumption of oral alimentation. Twenty-two and 48% of respondents use a salivary bypass tube for non-circumferential and circumferential defects respectively. Half of the respondents use postoperative barium swallows between 7-14 days. Conclusions: The results of this study indicated that there continues to be a high volume of reconstructive surgery of the pharyngoesophagus being performed by the membership of the AHNS. The very high numbers of flaps being performed for non-circumferential defects may be indicative of the frequent need to perform salvage surgery in the setting of prior chemoradiation and the benefit that well vascularized tissue brings to this category of wound. The majority of both circumferential and noncircumferential defects are being reconstructed using fascisocutaneous or myocutaneous free flaps, with a significant number of surgeons utilizing the pectoralis major myocutaneous flap for noncircumferential defects and free jejunal flaps for circumferential defects. Regardless of the techniques selected, surgeons use a similar set of criteria to determine their reconstructive approach.

S483 OUTCOMES OF FASCIO-CUTANEOUS FREE FLAPS RECONSTRUCTION FOR HYPOPHARYNGEAL DEFECTS Cesare Piazza, MD, Francesca Del Bon, MD, Valentina Taglietti, MD, Alberto Paderno, MD, Stefano Mangili, MD, Alberto Grammatica, MD, Piero Nicolai, MD; Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Italy Background Reconstruction of pharyngo-esophageal defects following resection of laryngo-hypopharyngeal cancer remains a challenge. Our purpose was to evaluate different reconstructive options after total laryngectomy (TL) with partial (PH) or circumferential hypopharyngectomy (CH) by analyzing the flap rate failure, complications, pharyngocutaneous fistula (PCF), and pharyngo-esophageal stricture (PES). Methods We compared an historical cohort of patients (Group A) treated between Jan 1996 and Dec 2008 and reconstructed by pedicled or fascio-cutaneous free flaps alone with a prospective cohort (Group B) operated on between Jan 2009 and June 2013 reconstructed by fascio-cutaneous free flaps with longlasting bypass salivary stent (BPSS). Group A (n= 89) was reconstructed by pectoralis major pedicled flap (PMPF) in 39 cases, radial forearm (RF) in 46, and anterolateral thigh (ALT) in 4. Forty-four (49%) received preoperative radiotherapy (RT) or chemoradiotherapy (CRT). Group B (n=79) was reconstructed by RF in 34 patients and ALT in 45, Fourty-five (57%) received preoperative RT/CRT. In every patient, we placed a long-lasting (45 days) BPSS fixed to the skin of the chin by non-reabsorbable stitch. Results In Group A, flap failure occurred in 4 (4%) cases all rescued by PMPF. We encountered 25 (28%) PCFs: 17 cured by medical treatment, and 8 by surgery (direct suture in 2 and PMPF in 6). Fifteen (17%) patients had late PES, managed by endoscopic dilatations in 11, a second free flap in 1, and permanent gastrostomy in 3. In Group B, flap failure occurred in 4 (6%) cases, which were managed by PMPF. BPSS was removed after a mean of 42 days (range, 18-60), with stent migration requiring early removal in 2 patients. We observed 5 (6%) PCFs: 2 cured by medical treatment and 3 by direct suture. Three (4%) patients experienced late PES, managed by endoscopic dilatations. At univariate analysis, comparing the occurrence of PCF and PES in Group A and B, statistically significant differences were found (p 3 months. Bronchoscopy was performed monthly post-repair on the longest surviving animal, and showed excellent graft incorporation into the tracheal wall. The airway remained widely patent without dehiscence or granulation despite substantial pig growth (200% increase in body weight by 2 months post-operatively.) Conclusions This technique can successfully repair anterior long segment tracheal stenosis without the need for endoluminal stents or immunosuppressive medications. The ability of the graft to sustain the porcine growth spurt may have significant clinical implications and expands use of this technique to recipients of all ages.