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In the past, some have said that wide clefts are better served with triangular repairs. As Millard repeatedly demonstrated2,10,11,12, this is not so; the principles of unit reconstruction need not be abandoned simply because the lip elements have a greater distance to travel.

Fig.19 and Fig.20 are two examples of the excellent results available to wide clefts when repaired with the R-A method. Although the width of the cleft does not play any role in deciding which technique to use, it is important to decide whether or not one should use presurgical orthodontics10 or do a lip adhesion before the definitive lip repair. Both, done shortly after birth, have the effect of molding the maxillary segments, resulting in less wound tension at the time of definitive lip repair several months later.

ABUSUS NON TOLLIT USUM (misuse does not nullify proper use).

In spite of the excellent descriptions of cleft lip repair in Millard's articles11, 12 and books2, 10 , one encounters patients who have unsatisfactory lips repaired by surgeons not yet comfortable with the R-A method. In fact, such examples are occasionally presented as rationale to avoid this technique, with the implication that the procedure, not the surgeon, is to blame. A good operation done poorly is not justification to condemn the procedure. When one sees such examples, one must seek to avoid making the same mistake(s) by understanding what the surgeon did, or did not do, that caused the unsatisfactory result. To this end, examples of unsatisfactory lip repairs will be shown with an analysis of their etiology. This will be followed by illustrating techniques which will prevent those untoward occurrences and help to assure a superior lip repair. This is not an iteration of Millard's step-wise descriptions of the R-A repair cited above; rather, assuming one's familiarity with the above, these observations are designed to be of help in carrying out some of those steps.

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