1466 Abstracts

Material and methods: In the present study we estimate thedensity of infiltrating neutrophils (cd66b+ and NE), macrophages(cd163+) and tumour cell proliferation (Ki67/MelanA) in 385 humanmelanoma samples with immunohistochemistry and computer-assisted image analysis. Furthermore, we use a translucentZebrafish larval model of Ras-driven neoplasia to live image theinteraction between inflammatory cells drawn to a wound and toadjacent pre-neoplastic cells.

Results: We show that neutrophils and macrophages are rapidlydistracted from the wound to competing attractants from pre-neoplastic cells and that these interactions lead to increased prolif-eration of the pre-neoplastic cells, entirely dependent upon innateimmune cells. The clinical data show that the density of infiltratingneutrophils correlates with elastase expression, the extent of ulcer-ation (percentage of the total tumour length) and tumour-cell pro-liferation in human melanoma. We found no correlation betweeninfiltrating macrophages and proliferation or prognosis.

Conclusion(s): In addition to the demonstrated inflammationinduced tumour-cell proliferation, we also see an independentprognostic link between neutrophil influx and melanoma specificsurvival, supporting the hypothesis that wound-induced inflamma-tion may be detrimental to patient survival, with neutrophils assuggested prime drivers.

MICROVASCULAR ABDOMINAL WALLTRANSPLANTATION- INDICATIONS, TECHNIQUESAND LESSONS LEARNT

Giele Henk

Oxford University Hospitals, United Kingdom

Introduction and aims: Abdominal wall transplantation is theonly method of single stage complete component abdominal wallreconstruction, yet only 15 cases have been reported world widefrom 2 centres, and only 3 have been microvascular cases.

Material and methods: Our recent experience of 13 abdominalwall reconstructions using abdominal wall transplantation iscompared to the 15 reported in the literature. Our data includingtechnique, ischaemic time, rejection, graft v host disease, immu-nosuppression protocols etc. was collated prospectively.

Results: A variety of techniques have been used and the prosand cons and learning points of these will be discussed. Allabdominal wall transplantations have been successful. No returnsto theatre for microvascular complications. This paper concen-trates on the technical aspects and learning points.

Conclusion(s): Microvascular Abdominal wall transplantation isa life-saving procedure reconstructing near normal anatomical andfunctional abdominal wall with additional benefits in transplantmonitoring.

IS HAND TRANSPLANTATION A VALID OPTION FORRECONSTRUCTION OF THE ABSENT UPPER LIMB?PART 1 e COSTS AND CHALLENGES OF SETTING UP ASERVICE

Simon P.J. Kay, Daniel J. Wilks, Maggie Bellew,Sarah Taplin

Leeds Teaching Hospitals NHS Trust, United Kingdom

Reflecting its complexity, development of the Leeds HandTransplantation programme took place over a four year period. Itscontinued activity requires the combined efforts of over75 healthcare professionals with a wide range of skills and training.

Here, we describe some of the many hurdles to establishing aviable composite tissue transplantation programme such as enlistingallied professionals, developing multidisciplinary teams, collabo-ratingwith international partners andnational organisations, securingfunding and developing protocols. We highlight the essential compo-nents of theprogramaswell as someof theunexpectedchallengesandsome of the many lessons learned whilst developing the service.

We also discuss the demand for hand transplantation. The pro-gramme, having been active for 18 months has, to date, receivedreferral of over 50 patients from a variety of sources and nations. Ofthese patients, four have been considered appropriate for transplant.

We also calculate the financial cost of the procedure and discussits place within the limits of a publicly funded, financially con-strained organisation such as the UK National Health Service.

ASSOCIATION OF WIDTH OF CLEFT PALATES WITHSURGICAL & FUNCTIONAL OUTCOMES e A 6-YEAREXPERIENCE

Muhammad A. Bashir 1, Fiona M. Perry 1,Reza Alamouti 1, Victoria Teoh 1, Norma Timoney 1

1 St. Thomas Hospital, United Kingdom

Introduction: Cleft width and potential fistula formation mayinfluence outcomes in children with clefts. We present data span-ning 6 years, looking at the width of the palate at the hard-softpalate junction, the use of lateral release incisions, fistula ratesand speech outcomes.

Methods: From 2005 onwards, 189 patients with all cleft types,were operated under the care of a single surgeon at the SouthThames Cleft Service. Data relating to cleft diagnosis, width ofcleft at the H-S junction, use of lateral release incisions, fistularates, CAPS-A and GOSPASS speech outcomes were collected.

Results: After exclusions, 158 patients were categorized ac-cording to cleft width into the following groups e

1. < 5mm (n Z 26)2. 5-9.9mm (nZ 72)3. 10-14.9mm (nZ 56)4. >15mm (nZ 4)We found that Group 3 had the greatest need for further in-

terventions in relation to speech outcomes and the necessity forfurther surgery. This correlated well with fistula of Pittsburgh types3 & 4.

Conclusion: While some recommend children with a cleft widthof >15mm undergo lateral release incisions, we found that lack ofreleasing incisions in the 10-14.9mm group correlated well with thepresence of fistulae and the need for further interventions.

STRUCTURAL ABNORMALITIES IN THE PALATEMUSCLES OF PATIENTS WITH CLEFT PALATE

Leila Rees 1,2, Thomas Jacques 1,2, Sebastian Brandner 3,Matthew Ellis 3, Erwin Pauws 1, Philip Stanier 1,Brian Sommerlad 2

1 UCL Institute of Child Health, United Kingdom2 Great Ormond Street Hospital for Children, United Kingdom3 UCL Institute of Neurology, United Kingdom

Introduction and aims: In some patients with cleft palate themuscles of the palate can look and handle differently during sur-gery and some have velopharyngeal insufficiency postoperativelywith nasal speech despite optimal repair. The purpose of this studywas to investigate whether there are any intrinsic structural ab-normalities in these palate muscles.