The role of plastic reconstructive surgery in surgical reconstruction of soft tissue defects after resection of musculoskeletal tumors

Background: Musculoskeletal tumor resections often result in large soft tissue defects that require complex reconstructive surgery to restore function and appearance. An interdisciplinary "orthoplastic" approach-coordinating orthopedic and plastic surgical expertise-aims to ensure durable wound coverage, minimize complications, and facilitate timely adjuvant therapies, ultimately improving functional recovery and oncologic outcomes. Methods: We retrospectively analyzed patients (2013-2020) at the First Department of Orthopedic Surgery, Athens University Medical School, "Attikon" University General Hospital. Focusing on sarcomas primarily in the lower extremities, pelvis, and sacrum, 56 patients underwent wide local resection and plastic reconstruction. Twenty-three of these 56 patients (41%) required wide local excision and pedicle or free flap reconstruction. Data included demographics, tumor characteristics, surgical details, and postoperative outcomes. Reconstructive technique choice depended on defect size, location, critical structure exposure, and prior radiation. Results: The orthoplastic approach, with meticulous planning and diverse reconstructive options, achieved acceptable morbidity and favorable functional and oncologic outcomes. This strategy ensured clear tumor margins with durable soft tissue coverage, protecting vital structures and minimizing wound complications, especially in limb-salvage cases requiring adjuvant radiotherapy. Our institutional data confirmed tailored reconstruction facilitated successful defect closure and timely adjuvant therapy. Conclusion: A collaborative orthoplastic approach is pivotal for soft tissue reconstruction after musculoskeletal tumor resection, improving limb preservation, outcomes, and reducing complications. While immediate reconstruction with well-vascularized tissue is beneficial, further research is needed to quantify its impact on quality of life and recurrence, and to establish evidence-based guidelines. Our experience highlights the frequent need for plastic surgery in extremity/pelvic sarcomas and the value of a flexible, tailored approach.