Plastic and reconstructive surgery in spinal sarcoma resection: a review of indications, techniques, and outcomes

Soft-tissue reconstruction following oncologic resection of spinal tumors often leaves extensive dead space vulnerable to infection, cerebrospinal fluid leak, and impaired function. En bloc resection with wide margins remains standard for disease control, but closure of these complex defects is challenging. Plastic and reconstructive surgeons (PRS) are often consulted for soft-tissue closure, yet their role in spinal sarcoma care has not been comprehensively reviewed. We aimed to (1) describe indications and timing of PRS consultation, (2) summarize reconstructive options by anatomic site, and (3) report outcome differences where comparative data were available.

Following PRISMA-ScR guidelines, we performed a scoping review of Scopus, PubMed, Embase, Web of Science, and CINAHL databases (January 2000-April 2025). Eligible studies reported spinal sarcoma or mixed oncologic spine cohorts with extractable sarcoma data undergoing flap-based or microvascular reconstruction with postoperative outcome data.

We included 21 primary studies encompassing 10,854 patients and four secondary sources; two additional narrative reviews published after the original search period were incorporated as contextual sources. PRS teams primarily employed flap-based closure in higher-risk patients, including those with prior irradiation, infection, large posterior defects, or multilevel instrumentation. In comparative observational cohorts, immediate flap-based closure was associated with lower wound complication rates and fewer hardware-related complications. Sacral and chest wall tumors were most anatomically complex, frequently requiring PRS consultation.

PRS involvement is preferentially utilized in higher-risk settings and is associated with comparable or lower wound morbidity, supporting early PRS consultation when high-risk features are present. These findings support standardized multidisciplinary consultation pathways and future validation of risk stratification tools in this patient population.