healing could reduce the vertical eyelid movement and result in lagophthalmos. 2 Therefore, to offset the vertical scar and to reconstruct the defects represent significant challenges for recreating functional eyelids.There are many methods to repair the eyelid defects, skin grafts, local flap, orbicularis oculi myocutaneous flap, or super-thin flap by tissue expansion. However, each method has its own advantages and shortages. 3 Propeller flaps are widely used in reconstructive surgery and considered a paradigm shift which enables the recruitment of mobile and flexible flaps from periocular area to the defect. 4 In our case, we have successfully applied the orbital subcutaneous pedicled propeller flap to reconstruct the upper eyelid defect. This flap also resolves the appearance of bloated skin on the lateral upper eyelid.Propeller flaps are classified into three types: random, skeletonized perforator and supercharged, while flaps with random subcutaneous pedicle have been called subcutaneous island flaps. 1 In theory, propeller flaps are best supported by perforators as this may improve blood supply to the distal part of flaps. However, in the highly vascular periocular areas, using subcutaneous pedicled flaps is also safe and the 1808-rotations are also effective. Moreover, despite the use of named perforators, venous congestion is still reported in 5/22 cases, of which two had partial flap necrosis. 5 These suggest that the clinical application prospect of random propeller flaps is very broad.The orbital subcutaneous pedicled propeller flap is easy to manipulate. And according to our previous study, 6 we consider that this flap is also personality. Although this flap is successful in our patient, the treatment strategy must be generated on a case-bycase basis to fit the needs of the patient. There are some technical points to emphasis. The flap size should be templated form the defect or undersize slightly, which may decrease the incidence of trapdooring or edema post-operative. Second, once the flap is fully prepared, it is recommended that the flap staying in situ for 10 to 15 min before rotating, allows the pedicle to fully perfuse. Still, laser therapy is appropriate and efficient in the further to treat the remaining scar and aesthetic problem in this case.

Objective To investigate the demographics of CORE grant recipients (Centralized Otolaryngology Research Efforts) over the last decade and evaluate disparity among recipients as compared with otolaryngology overall. To assess whether procurement of a grant predicts pursuit of an academic career. Study Design Analysis of grant recipients’ bibliometrics. Setting Academic medical center. Methods The list of recipients of grants from 2010 to 2019 was obtained from the website of the American Academy of Otolaryngology–Head and Neck Surgery. Demographics of recipients were collected through an internet search, including gender, race, residency program, and h-index. Recipients from 2010 were searched to determine current academic faculty rank. Univariate and multivariate analyses were used to compare these factors with otolaryngology overall. Results The distribution of gender among recipients over the last decade remained nearly constant, with no significant difference versus residents in otolaryngology ( P > .05). However, there were significantly more female recipients when adjusted for gender differences in the field overall ( P < .01). Asians were relatively overrepresented, while Black and Hispanic residents were underrepresented ( P < .01). Many recipients (52.6%) trained at institutions recognized as the best training programs with reputations for quality research output. The h-index of recipients decreased over the last decade ( P < .01). The h-index of duplicate winners was significantly higher than those of nonduplicate winners ( P < .01). After adjusting for gender and rank, recipients were significantly more likely to hold academic positions ( P < .01). Conclusion CORE grants are favorably distributed as related to gender and racial disparities, and recipients frequently go on to achieve high levels of academic success.

Objective: Our goal was to compare the perceptions of overseas orthopaedic volunteers and their hosts in low-and middle-income countries (LMICs) regarding the role of international volunteerism. We also sought to determine if differences in perception exist between trainee and fully trained orthoapedic surgeon volunteers. Methods: Surveys with similar multiple-choice and open-ended questions were administered to 163 Health Volunteers Overseas orthopaedic volunteers (response rate 45%) and 53 members of the host orthopaedic staff (response rate 40%). Fifty-four volunteers and 20 hosts also contributed open-ended responses. Quantitative responses were analyzed for significance using Mantel-Haenzel x 2 tests. Open-ended responses were coded using thematic analysis.Results: Both the international volunteers and their LMIC hosts agreed that volunteers learned new skills while volunteering. Both groups believed that international volunteerism had a positive overall impact on the local practice, but hosts viewed these benefits more favorably than volunteers did. LMIC staff believed that, besides altruistic reasons, volunteers were also motivated by professional gains, diverging from volunteer responses. In open-ended responses, hosts desired longer term commitments from volunteers and had some concerns regarding volunteers' qualifications. Between volunteer trainees and fully trained surgeons, trainees were more likely to be motivated by personal benefits. Conclusion:Efforts must be made to further align the expectations and goals of volunteers and their hosts in LMICs. Certain measures such as predeparture orientations for volunteers and developing a more longitudinal and bidirectional experience may enhance the impact of orthopaedic volunteerism in LMICs. Further studies are needed to explore the impact of international orthopaedic volunteerism on the host population.

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Background/Objectives: Primary cutaneous adenoid cystic carcinoma (PCACC) is a rare skin tumor. The head and neck (H&N) is the most common anatomical location. Due to limited published cases, its clinical course and management are not well understood. Methods: The National Cancer Database (NCDB) was queried for all cases of H&N PCACC diagnosed from 2004 to 2016. Kaplan–Meier (KM) and Cox proportional hazards models were used to determine clinicopathological and treatment factors associated with survival outcomes. Results: A total of 201 cases were analyzed. The average age of diagnosis was 57.7 years (± SD 15.8). There was a female predilection (57.7%; P < .05) with the most common primary site being the ear (58.2%). The average tumor size was 15.9 mm in diameter. The most common treatment was surgery alone (51.7%) with wide local excision being the common surgery performed (36.3%). 5-year and 10-year OS were 87.0% and 76.0%, respectively. A total of 65.8% of cases were localized (Stage I and II). KM analysis indicated that gender, age, insurance status, Charlson-Deyo Comobordity Score, and stage were significant predictors of OS ( P < .05). Cox proportional hazards analysis revealed that patients with both private (HR 0.11, 95%CI [0.019-0.670]; P = .02) and government (HR 0.12, 95%CI [0.019-0.972]; P = .03) health insurance had a significantly decreased hazard of death than patients who were uninsured. Increasing age was associated with an increased hazard of death (HR 1.06, 95%CI [1.016-1.110]; P = .01). Conclusion: This study represents the largest cohort of H&N PCACC studied to date and provides important clinicopathologic information for this rare tumor. Additionally, our results emphasize the importance of health insurance as an independent predictor of survival in PCACC.