Lead arsenate is an environmentally hazardous contaminant that was applied as a pesticide in orchards during the early 1900s. Elevated arsenic (As) concentrations persist in soils where lead arsenate was applied. To assess the risk associated with historic lead arsenate contamination, the retention, bioavailability, and speciation of soil As were evaluated in three historically contaminated orchard soils. Stirred-flow desorption studies and in vitro physiologically based extractions were used to assess the mobility and relative bioavailability of soil As, respectively. Synchrotron-based X-ray absorption spectroscopy was used to determine soil As speciation. Arsenic concentrations in former orchard soils ranged from 11.8 to 59.0 mg kg. Less than 22% of total As was considered bioavailable according to in vitro extractions. Up to 15% of soil As was desorbed in 10 mM KCl, but desorption with phosphate solutions resulted in release of up to 70% of total As dependent on soil type. Desorption data suggest that arsenate is primarily sorbed via inner-sphere complexation, and elevated concentrations of competing ions in soil solution may increase mobility of soil As. Arsenic was primarily present in the As(V) oxidation state, the less mobile form of As. Combined results from X-ray absorption spectroscopy and desorption studies indicate that As primarily exists as sorbed species, likely to ubiquitously present Fe- and Al-oxides in soils. Results demonstrate that soil As from these historically contaminated orchards is mostly in stable, nonhazardous forms, but factors such as Fe- and Al-oxide content and land management practices have a significant effect on As transport and bioavailability.

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Background: Outcomes and cost of soft tissue versus bony midface free flap reconstruction (MR) with and without virtual surgical planning (VSP) were evaluated. Methods: Retrospective review of MR including ischemic time (IT), operative duration (OD), length of stay (LOS), and total cost (TC). Eighty-one soft tissue and 76 bony MR (VSP = 23) were reviewed. Results: Bony MR was used for higher complexity defects (p = 0.003) and was associated with higher IT (p < 0.001), OD (p < 0.001), LOS (p = 0.032), and TC (p < 0.001). VSP was associated with a mean 111.2 ± 37.9 minute reduction in OD (p = 0.004) compared to non-VSP bony flaps. VSP was associated with higher itemized cost, but no increase in TC (p = 0.327).Conclusions: Bony MR was used for higher complexity MR and was associated with increased TC, LOS, OD, and IT. VSP shortened OD with no significant increase in TC.

ObjectivePatients with recurrent oropharyngeal cancer can achieve survival benefits from surgical salvage, and often require simultaneous free‐flap reconstruction. Resection and reconstruction can impact function, leading to tube dependence. Primary objective: describe rates of tracheostomy and gastrostomy tube dependence after oropharyngeal resection and free flap after prior radiation. Secondary objective: evaluate patient, tumor, and treatment factors associated with tube dependence.Study DesignRetrospective, multi‐institutional cohort study. Patients treated from 2003 to 2020. Average follow‐up 21.4 months.SettingFive tertiary care centers.MethodsConsecutive cohort of patients undergoing resection and simultaneous free‐flap reconstruction for oropharyngeal squamous cell carcinoma after head and neck radiation. Primary outcomes: gastrostomy tube dependence and tracheostomy or tracheostoma 1 year after surgery. Univariable and multivariable logistic regression were performed to identify factors associated with dependence.Results89 patients underwent oropharyngectomy and free‐flap reconstruction; 18 (20%) underwent total laryngectomy as part of tumor extirpation. After surgery, 51 patients (57%) lived 12 months. Among patients alive at 12 months, 22 (43%) were at least partially‐dependent on gastrostomy tube, and 15 (29%) had either tracheostomy or tracheostoma. On multivariable analysis, extensive glossectomy (OR 16.6, 95% CI 1.83–389, p = 0.026) and total laryngectomy (OR 11.2, 95% CI 1.71–105, p = 0.018) were associated with long‐term gastrostomy tube. No factors were associated with long‐term tracheostomy on multivariable analysis.ConclusionEven among long‐term survivors after salvage resection and free‐flap reconstruction, rates of tube dependence are significant. This multi‐institutional review is the largest such study to the date and may help inform shared decision‐making.Level of Evidence4 Laryngoscope, 133:2141–2147, 2023

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