The role of orthoplastic surgery in musculoskeletal oncology.

The orthoplastic approach refers to an integrated evaluation of the surgical approach, the preoperative planning of surgical margins of resection, the loss of healthy tissue, the size of the resultant tissue defect, the functional defect, the impact of neoadjuvant therapies on local tissue, the patient's comorbidities, and predicted survival in order to decide the most favorable reconstruction option for the individual patient with a sarcoma. Microsurgical techniques are an essential component of the tissue reconstruction ladder. The vascularity of the flap used for reconstruction does not compromise the oncological outcomes, nor does it increase local recurrence or reduce overall survival. Free-vascularized fibula grafts are the most common osseous flaps used for bone defect reconstruction. Adequate fixation is necessary to provide mechanical stability and to increase the rate of primary bone union. Soft tissue wound closure under tension results in wound failure, especially when preoperative radiation therapy is used. Flap reconstruction decreases the rate of wound healing complications, allowing for continuation of adjuvant therapies. Soft-tissue local flaps are frequently used to treat tissue defects with a low complication rate. Plastic reconstruction should be tailored to the specific needs of patients.