Three-Dimensional Soft Tissue Reconstructive Planning in Orthoplastic Oncology: A Systematic Review

Complex orthopedic oncology cases require coordinated planning between tumor surgeons and reconstructive plastic surgeons, yet a technological disconnect exists. While orthopedic oncologists seek to achieve millimeter-level precision using three-dimensional-guided systems for bone tumor resection from computed tomography scan reformats, plastic surgeons rely on traditional two-dimensional imaging for reconstructive planning in the same cases. We conducted a systematic review of reviews examining three-dimensional technologies in orthopedic oncology and their relevance to soft tissue reconstructive planning. We searched PubMed, Embase, and Cochrane databases through November 2024, using terms combining "three-dimensional", "orthopedic oncology", and "bone tumor". Two independent reviewers performed dual screening with disagreements resolved by consensus. After reviewing 325 articles, we identified 16 reviews (three systematic, 13 narrative) published between 2009 and 2024. Despite comprehensive evaluation across these reviews encompassing hundreds of primary studies, no applications for soft tissue reconstruction planning were identified. Orthopedic teams demonstrated remarkable progress in precision with patient-specific instrumentation achieving superior negative margin rates (89% versus 68% for conventional methods) and cutting deviations of 0.3-4 mm, yet the same imaging data used for skeletal planning, containing nearly all information necessary for soft tissue reconstruction, remained unutilized for reconstructive purposes. Three-dimensional planning technologies have transformed orthopedic oncology but are typically absent from soft tissue reconstruction planning in the same cases. A significant opportunity exists for plastic surgeons to integrate into existing three-dimensional workflows through defect volume analysis, vessel mapping, flap design optimization, and coordinated reconstructive timing within navigation-guided resections.