The Craft of Cleft surgery continue to be the core or craniofacial surgery. Surgical repair of clefts in children can be the most demanding and complex of the repara-tive procedures that are done in plastic surgery. The key issue is that a long term follow up over many years is as important as the repair and the technical skills of the different operative procedures involved. A repair without a follow up is meaningless to talk about. Yet, in many centers it has been taken lightly and relegated to the person on a low rung of the experience ladder with comparable knowledge and skill, especially today as third party reimbursements are dwindling. The reason also is that the little ones as patients cannot speak for themselves are many, not the least of which is that functional outcome of the repair takes years to be judged, evaluated and assessed functionally. The assigned beginner surgeon's lack of the technical skill and understanding, knowledge of the how's and whys in the reparative procedures may be below par as all the interest is focused on the patient getting the procedure done and the patient getting out of the hospital. A well rounded training involves working in dedicated centers for care before branching out to the creation or the start up of a new one.
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