Appendicular Soft Tissue Sarcoma Surgery in the Era of Orthoplastics

Appendicular soft tissue sarcoma (aSTS) is a group of highly heterogeneous tumors of mesenchymal origin for which standard care usually includes surgical resection with or without radiation therapy. The main goal of surgical treatment in aSTS is to achieve wide tumor resection with negative margins while promoting the best function possible for the affected limb. Orthoplastic surgery represents the concept of a multidisciplinary approach comprising a synergistic collaboration between orthopedic and plastic surgeons. The development of this philosophy allows us to push forward the concept of limb salvage surgery for sarcomas, even when dealing with extremely complex cases. Reconstruction techniques integrated with orthoplastic principles range from simple to highly complex surgeries. Vascularized auto- or allo-graft tissue transfers illustrate how far reconstruction options can go, allowing for repair of large soft tissue defects or even restoration of muscle function in key anatomic segments after oncological resection. The reported experience with orthoplastic philosophy in aSTS suggests that it is a feasible and reproducible strategy that can achieve limb salvage rates above 90%, optimal oncologic local control characterized by more than 95% of wide margin resection, and improved functional and esthetic results. Most patients with aSTS treated under orthoplastic principles present good-to-excellent postoperative Musculoskeletal Oncology Society (MSTS) scores, confirming the advantages of this comprehensive approach. While there is significant experience with the orthoplastic approach for trauma cases, the road still needs to be paved for musculoskeletal oncologic reconstruction. Nonetheless, the results are promising and could inspire a wider adoption of structured orthoplastic protocols for sarcoma patient care. Herein, the authors explore the current practice regarding the application of collaborative orthoplastic approaches for the management of appendicular soft tissue sarcomas, reporting on outcomes and elaborating on future trends.