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Abstract Background Soft tissue sarcomas affecting the root of an upper extremity raise the question of limb amputation depending on their location, size, and malignancy. Malignant triton tumors are a rare subtype of neurofibrosarcomas that have been poorly reported in the literature. We report the case of a challenging reconstruction of the upper extremity using a pedicled latissimus dorsal flap. Case presentation A 25-year-old Occidental man was referred to our sarcoma unit for the management of a large, high-grade malignant peripheral nerve sheath tumor with no regional or distant extension and very fast progression. He was treated first by concomitant neoadjuvant radiotherapy and chemotherapy. Carcinologic excision was performed “en bloc” including the skin, the tumor, and the flexor muscles of our patient’s elbow. Coverage of the skin defect and elbow flexion restoration were achieved by using a homolateral pedicled musculocutaneous latissimus dorsi flap. Histological analysis showed an R0 resection. The reconstruction process recovered a complete bending of his elbow. He is still in remission at 26 months follow-up. Conclusions A malignant triton tumor is a rare, aggressive, and high-grade sarcoma. It was successfully treated and this case report describes an effective treatment modality. Reconstructive surgery, allowing large, complete tumor removal, is indispensable after neoadjuvant chemotherapy and radiotherapy.

Purpose: The current gold standard in organ storage is static cold storage (SCS) at 4°C in a preservation solution (UW, HTK). While kidneys can be stored for 24 hours in SCS, Vascularized Composite Allografts (VCA) have been transplanted up to 12 hours in this condition. We aimed to determine the limits of VCA viability with SCS. We used a partial heterotopic hindlimb transplantation model on rodent to assess VCA survival at various durations of SCS. Methods: Right partial hind limbs in Lewis rats were procured and a 24G Angiocath inserted in the femoral artery. Limbs were flushed with 2ml of heparin saline (100UI/ml) at room temperature and then 5ml of ice cold HTK solution. The limbs were then immersed in HTK in a sterile bag and stored at 4°C for a period of 12(group 1), 18(group 2), 24(group 3), 48 (group 4) or 0 hours (fresh controls Group 5), before microsurgical transfer to the opposite groin. Graft weight was assessed before and after cold storage. At post-operative day (POD) 21, VCAs were harvested for histological analysis. Results: In all groups, there was no significant difference of weight gain in SCS groups after extended SCS times. In group 1 (n=4), 3 rats survived until POD21; clinical evolution showed a limited epidermolysis (