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It is the author's belief that poor healing due to deficient mesenchyme at the junction of the hard and soft palates probably constitutes the essential reason for some failures of palatoplasty. In order to provide extra tissue to reinforce the above-mentioned region and to facilitate efficient velar lengthening, the use of an extension of the vomer flap detached from the roof of the pharynx is proposed. Such extended vomer flaps have been applied successfully both on the oral and nasal sides in 50 patients. The necessity of further and longer observations is obvious.

A new method consisting of conversion of the retroauricular skin into an axial flap is described. During the first stage the superficial temporal vessels are transposed under the skin of the retroauricular region. The second operative step consists of elevation of the retroauricular-mastoid skin on the dissected axial pedicle. The secondary island flaps proved to be efficient in the repair of small and medium-sized defects of the facial region.

On the basis of about 60 cases, we discuss the clinical use of groin, latissimus dorsi, dorsalis pedis, scapular, parascapular, and forearm free flaps. These flaps are evaluated in relation to some alternate reconstructive procedures in various regions of the body, with photographic documentation.

The author's original approach to the early repair of cleft palate which consists in the use of the extended vomer flap is presented. The evolution of primary procedure under the influence of the philosophy of Malek and Psaume and all additional improvements of the author are described and illustrated. The early results (up to 6 years) of 40 palatoplasties performed at the ages of 3-6 months are roughly evaluated and discussed.

The author presents a new method of early columella elongation used since 1982 in the repair of 52 bilateral clefts. The method is suitable for two-stage lip repair without a strict muscle union behind the prolabium. So far, the results seem to be promising, since the children's postoperative appearance is almost normal and the disadvantages due to the so-called sheep nose deformity can be avoided.