title: 30-year International Pediatric Craniofacial Surgery Partnership: Evolution from the "Third World" Forward.
abstract: BACKGROUND
  Craniofacial diseases constitute an important component of the surgical disease burden in low- and middle-income countries. The consideration to introduce craniofacial surgery into such settings poses different questions, risks, and challenges compared with cleft or other forms of plastic surgery. We report the evolution, innovations, and challenges of a 30-year international craniofacial surgery partnership.
  
  
  METHODS
  We retrospectively report a partnership between surgeons at the Uniwersytecki Szpital Dzieciecy in Krakow, Poland, and a North American craniofacial surgeon. We studied patient conditions, treatment patterns, and associated complications, as well as program advancements and limitations as perceived by surgeons, patient families, and hospital administrators.
  
  
  RESULTS
  Since partnership inception in 1986, the complexity of cases performed increased gradually, with the first intracranial case performed in 1995. In the most recent 10-year period (2006-2015), 85 patients have been evaluated, with most common diagnoses of Apert syndrome, Crouzon syndrome, and single-suture craniosynostosis. In the same period, 55 major surgical procedures have been undertaken, with LeFort III midface distraction, posterior vault distraction, and frontoorbital advancement performed most frequently. Key innovations have been the employment of craniofacial distraction osteogenesis, the use of Internet communication and digital photography, and increased understanding of how craniofacial morphology may improve in the absence of surgical intervention. Ongoing challenges include prohibitive training pathways for pediatric plastic surgeons, difficulty in coordinating care with surgeons in other institutions, and limited medical and material resources.
  
  
  CONCLUSIONS
  Safe craniofacial surgery can be introduced and sustained in a resource-limited setting through an international partnership.
authors.affiliation: Division of Plastic Surgery, Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, Pa.; and Division of Pediatric Surgery, Uniwersytecki Szpital Dzieciecy (University Children's Hospital) and Jagellonion University, Krakow, Poland.
authors.forename: Jordan W
authors.initials: JW
authors.lastname: Swanson
authors.affiliation: Division of Plastic Surgery, Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, Pa.; and Division of Pediatric Surgery, Uniwersytecki Szpital Dzieciecy (University Children's Hospital) and Jagellonion University, Krakow, Poland.
authors.forename: Jan
authors.initials: J
authors.lastname: Skirpan
authors.affiliation: Division of Plastic Surgery, Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, Pa.; and Division of Pediatric Surgery, Uniwersytecki Szpital Dzieciecy (University Children's Hospital) and Jagellonion University, Krakow, Poland.
authors.forename: Beata
authors.initials: B
authors.lastname: Stanek
authors.affiliation: Division of Plastic Surgery, Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, Pa.; and Division of Pediatric Surgery, Uniwersytecki Szpital Dzieciecy (University Children's Hospital) and Jagellonion University, Krakow, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Kowalczyk
authors.affiliation: Division of Plastic Surgery, Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, Pa.; and Division of Pediatric Surgery, Uniwersytecki Szpital Dzieciecy (University Children's Hospital) and Jagellonion University, Krakow, Poland.
authors.forename: Scott P
authors.initials: SP
authors.lastname: Bartlett