title: Current surgical practices in cleft care: cleft palate repair techniques and postoperative care.
abstract: BACKGROUND
  The purpose of this study was to objectively report practices commonly used in cleft palate repair in the United States. This study investigates current surgical techniques, postoperative care, and complication rates for cleft palate repair surgery.
  
  
  METHODS
  All 803 surgeon members of the American Cleft Palate-Craniofacial Association were sent online and/or paper surveys inquiring about their management of cleft palate patients.
  
  
  RESULTS
  Three-hundred six surveys were received, a 38 percent response rate. This represented responses of surgeons from 100 percent of American Cleft Palate-Craniofacial Association registered cleft teams. Ninety-six percent of respondents perform a one-stage repair. Eighty-five percent of surgeons perform palate surgery when the patient is between 6 and 12 months of age. The most common one-stage repair techniques are the Bardach style (two flaps) with intravelar veloplasty and the Furlow palatoplasty. After surgery, 39 percent of surgeons discharge patients within 24 hours. Another 43 percent discharge patients within 48 hours. During postoperative management, 92 percent of respondents implement feeding restrictions. Eighty-five percent of physicians use arm restraints. Surgeons' self-reported complications rates are minimal: 54 percent report a fistula in less than 5 percent of cases. The reported need for secondary speech surgery varies widely.
  
  
  CONCLUSIONS
  The majority of respondents repair clefts in one stage. The most frequently used repair techniques are the Furlow palatoplasty and the Bardach style with intravelar veloplasty. After surgery, the majority of surgeons discharge patients in 1 or 2 days, and nearly all surgeons implement feeding restrictions and the use of arm restraints. The varying feeding protocols are reviewed in this article.
authors.affiliation: Rochester, N.Y.; and Durham, N.C. From the University of Rochester School of Medicine and Duke University.
authors.forename: Evan B
authors.initials: EB
authors.lastname: Katzel
authors.forename: Patrick
authors.initials: P
authors.lastname: Basile
authors.forename: Peter F
authors.initials: PF
authors.lastname: Koltz
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Marcus
authors.forename: John A
authors.initials: JA
authors.lastname: Girotto
mesh_terms: D002972:Cleft Palate / Q000601:surgery*; D003625:Data Collection; D006801:Humans; D007223:Infant; D011182:Postoperative Care / Q000379:methods* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D014481:United States