Plastic Surgical Considerations in Musculoskeletal Oncology

The treatment of musculoskeletal sarcoma (MSS) has evolved over the past 30 years from a primarily surgical, limb-sacrificing protocol to a multimodal limb-sparing approach including surgery, radiation therapy, and chemotherapy. The need for plastic surgical techniques to reconstruct limb-sparing defects and promote healing of radiated tissues developed in lockstep with this modern system of treatment. Because MSS can arise in almost any anatomical region of the body, restorative procedures draw from the vast armamentarium of plastic surgical techniques. This chapter reviews the thought processes involved in selecting, evaluating, preparing, and reconstructing patients with composite tissue defects due to MSS eradication. Focus is directed toward thorough communication with the multidisciplinary MSS team, engineering successful surgery via preoperative preparation, and selecting a reconstructive plan tailored to the patient and the defect.