{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T18:40:05Z","timestamp":1791312005019,"version":"4.3.1"},"reference-count":54,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2020,12,14]],"date-time":"2020-12-14T00:00:00Z","timestamp":1607904000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background and Objectives. Wide surgical resection is a relevant factor for local control in sarcomas. Plastic surgery is mandatory in demanding reconstructions. We analyzed patients treated by a multidisciplinary team to evaluate indications and surgical approaches, complications and therapeutic\/functional outcomes. Methods. We analyzed 161 patients (86 males (53%), mean age 56 years) from 2006 to 2017. Patients were treated for their primary tumor (120, 75.5%) or after unplanned excision\/recurrence (41, 25.5%). Sites included lower limbs (36.6%), upper limbs (19.2%), head\/neck (21.1%), trunk (14.9%) and pelvis (8.1%). Orthoplasty has been considered for flaps (54), skin grafts (42), wide excisions (40) and other procedures (25). Results. At a mean follow-up of 5.3 years (range 2\u201310.5), patients continuously showed no evidence of disease (NED) in 130 cases (80.7%), were alive with disease (AWD) in 10 cases (6.2%) and were dead with disease (DWD) in 21 cases (13.0%). Overall, 62 patients (38.5%) developed a complication (56 minor (90.3%) and 6 major (9.7%)). Flap loss occurred in 5\/48 patients (10.4%). The mean Musculoskeletal Tumor Society (MSTS) and Toronto Extremity Salvage Score (TESS) was 74.8 \u00b1 14 and 79.1 \u00b1 13, respectively. Conclusions. Orthoplasty is a combined approach effective in management of sarcoma patients, maximizing adequate surgical resection, limb salvaging and functional recovery. One-stage reconstructions are technically feasible and are not associated with increased risk of complications.<\/jats:p>","DOI":"10.3390\/jpm10040278","type":"journal-article","created":{"date-parts":[[2020,12,14]],"date-time":"2020-12-14T21:25:08Z","timestamp":1607981108000},"page":"278","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["One-Stage Soft Tissue Reconstruction Following Sarcoma Excision: A Personalized Multidisciplinary Approach Called \u201cOrthoplasty\u201d"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8823-448X","authenticated-orcid":false,"given":"Andrea","family":"Angelini","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Orthopedic Oncology, University of Padova, 35122 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesare","family":"Tiengo","sequence":"additional","affiliation":[{"name":"Clinic of Plastic Surgery, University of Padova, 35122 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9136-7507","authenticated-orcid":false,"given":"Regina","family":"Sonda","sequence":"additional","affiliation":[{"name":"Clinic of Plastic Surgery, University of Padova, 35122 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Berizzi","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Orthopedic Oncology, University of Padova, 35122 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franco","family":"Bassetto","sequence":"additional","affiliation":[{"name":"Clinic of Plastic Surgery, University of Padova, 35122 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9617-9882","authenticated-orcid":false,"given":"Pietro","family":"Ruggieri","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Orthopedic Oncology, University of Padova, 35122 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,12,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1097\/00000658-198209000-00009","article-title":"The treatment of soft-tissue sarcomas of the extremities: Prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy","volume":"196","author":"Rosenberg","year":"1982","journal-title":"Ann. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1007\/BF02303867","article-title":"Combined modality treatment of extremity soft tissue sarcomas","volume":"5","author":"Pisters","year":"1998","journal-title":"Ann. Surg. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1055\/s-0032-1329920","article-title":"Outcomes analysis of the role of plastic surgery in extremity sarcoma treatment","volume":"29","author":"Agrawal","year":"2013","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"418","DOI":"10.2106\/JBJS.J.00834","article-title":"Failure mode classification for tumor endoprostheses: Retrospective review of five institutions and a literature review","volume":"93","author":"Henderson","year":"2011","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_5","first-page":"129","article-title":"Megaprosthesis of the knee in tumor and revision surgery","volume":"88","author":"Pala","year":"2017","journal-title":"Acta Biomed."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1007\/s11999-014-3699-2","article-title":"Survival of Modern Knee Tumor Megaprostheses: Failures, Functional Results, and a Comparative Statistical Analysis","volume":"473","author":"Pala","year":"2015","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2530","DOI":"10.1002\/cncr.11365","article-title":"Prognostic factors for patients with localized soft-tissue sarcoma treated with conservation surgery and radiation therapy: An analysis of 1225 patients","volume":"97","author":"Zagars","year":"2003","journal-title":"Cancer"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1097\/00003086-199301000-00035","article-title":"A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system","volume":"286","author":"Enneking","year":"1993","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1007\/BF00540024","article-title":"Development of a measure of physical function for patients with bone and soft tissue sarcoma","volume":"5","author":"Davis","year":"1996","journal-title":"Qual. Life Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/S0030-5898(20)31815-0","article-title":"The reconstructive ladder. An orthoplastic approach","volume":"24","author":"Levin","year":"1993","journal-title":"Orthop. Clin. N. Am."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1016\/j.bjps.2017.02.017","article-title":"Orthoplastic surgical collaboration is required to optimise the treatment of severe limb injuries: A multi-centre, prospective cohort study","volume":"70","author":"Boriani","year":"2017","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1097\/BOT.0000000000000246","article-title":"A lower extremity musculo-skeletal and vascular trauma protocol in a children\u2019s hospital may improve treatment response times and appropriate microvascular coverage","volume":"29","author":"Gans","year":"2015","journal-title":"J. Orthop. Trauma"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1245\/s10434-010-0915-5","article-title":"Function and health status outcomes following soft tissue reconstruction for limb preservation in extremity soft tissue sarcoma","volume":"17","author":"Davidge","year":"2010","journal-title":"Ann. Surg. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1016\/j.ejso.2014.05.004","article-title":"Outcomes after flap reconstruction for extremity soft tissue sarcoma: A case-control study using propensity score analysis","volume":"40","author":"Kang","year":"2014","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1097\/01.PRS.0000131987.40578.7B","article-title":"Upper extremity limb salvage with microvascular reconstruction in patients with advanced sarcoma","volume":"114","author":"Kim","year":"2004","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"7972318","DOI":"10.1155\/2016\/7972318","article-title":"Immediate versus Delayed Sarcoma Reconstruction: Impact on Outcomes","volume":"2016","author":"Sanniec","year":"2016","journal-title":"Sarcoma"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1016\/j.ejso.2017.01.016","article-title":"Patient, tumour and treatment factors affect complication rates in soft tissue sarcoma flap reconstruction in a synergistic manner","volume":"43","author":"Slump","year":"2017","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1002\/jso.24205","article-title":"Consideration in lower extremity reconstruction following oncologic surgery: Patient selection, surgical techniques, and outcomes","volume":"113","author":"Suh","year":"2016","journal-title":"J. Surg. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2484","DOI":"10.1245\/s10434-014-3732-4","article-title":"Efficacy of adjuvant radiation therapy in the treatment of soft tissue sarcoma of the extremity: 20-year follow-up of a randomized prospective trial","volume":"21","author":"Beane","year":"2014","journal-title":"Ann. Surg. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1615\/JLongTermEffMedImplants.v20.i1.10","article-title":"Side effects of chemotherapy in musculoskeletal oncology","volume":"20","author":"Mavrogenis","year":"2010","journal-title":"J. Long-Term Eff. Med. Implant."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1016\/S0360-3016(01)02807-3","article-title":"The effect of delayed postoperative irradiation on local control of soft tissue sarcomas of the extremity and torso","volume":"52","author":"Schwartz","year":"2002","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s11864-015-0346-4","article-title":"Preoperative therapy for extremity soft tissue sarcomas","volume":"16","author":"Davis","year":"2015","journal-title":"Curr. Treat. Options Oncol."},{"key":"ref_24","first-page":"104","article-title":"Staged soft tissue reconstruction following sarcoma excision with anticipated large cutaneous defects: An oncologically safe alternative","volume":"36","author":"Siegel","year":"2016","journal-title":"IOWA Orthop."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2235","DOI":"10.1016\/S0140-6736(02)09292-9","article-title":"Preoperative versus post-operative radiotherapy in soft-tissue sarcoma of the limbs: A randomised trial","volume":"359","author":"Bell","year":"2002","journal-title":"Lancet"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2455","DOI":"10.1002\/cncr.22298","article-title":"Complications of combined modality treatment of primary lower extremity soft-tissue sarcomas","volume":"107","author":"Cannon","year":"2006","journal-title":"Cancer"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1097\/00006534-199404001-00012","article-title":"Wound-healing complications after soft-tissue sarcoma surgery","volume":"93","author":"Peat","year":"1994","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1097\/00000658-199211000-00011","article-title":"Vascularized tissue transfer for closure of irradiated wounds after soft tissue sarcoma resection","volume":"216","author":"Barwick","year":"1992","journal-title":"Ann. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1002\/jso.20629","article-title":"Preoperative chemoradiation and flap reconstruction provide high local control and low wound complication rates for patients undergoing limb salvage surgery for upper extremity tumors","volume":"95","author":"Temple","year":"2007","journal-title":"J. Surg. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1016\/j.crad.2008.06.009","article-title":"The cancer reform strategy","volume":"63","author":"Shaw","year":"2008","journal-title":"Clin. Radiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e672","DOI":"10.3928\/01477447-20120426-21","article-title":"Reconstruction of the extensor mechanism after major knee resection","volume":"35","author":"Mavrogenis","year":"2012","journal-title":"Orthopedics"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1002\/jso.23216","article-title":"Proximal tibial resections and reconstructions: Clinical outcome of 225 patients","volume":"107","author":"Mavrogenis","year":"2013","journal-title":"J. Surg. Oncol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/s00264-018-4232-0","article-title":"Three-dimension-printed custom-made prosthetic reconstructions: From revision surgery to oncologic reconstructions","volume":"43","author":"Angelini","year":"2019","journal-title":"Int. Orthop."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Angelini, A., Kotrych, D., Trovarelli, G., Szafra\u0144ski, A., Bohatyrewicz, A., and Ruggieri, P. (2020). Analysis of principles inspiring design of three-dimensional-printed custom-made prostheses in two referral centres. Int. Orthop.","DOI":"10.1007\/s00264-020-04523-y"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1508","DOI":"10.1016\/j.arth.2011.02.018","article-title":"Clinical effectiveness of hemipelvic reconstruction using computer-aided custom-made prostheses after resection of malignant pelvic tumors","volume":"26","author":"Sun","year":"2011","journal-title":"J. Arthroplasty."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1007\/s00264-017-3645-5","article-title":"Computer-aided designed, three dimensional-printed hemipelvic prosthesis for peri-acetabularmalignant bone tumour","volume":"42","author":"Wang","year":"2018","journal-title":"Int. Orthop."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1007\/s11999-013-3250-x","article-title":"Infection after surgical resection for pelvic bone tumors: An analysis of 270 patients from one institution","volume":"472","author":"Angelini","year":"2014","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2256","DOI":"10.1002\/cncr.10419","article-title":"Soft tissue sarcoma of the upper extremity: A 5-year experience at two institutions emphasizing the role of soft tissue flap reconstruction","volume":"94","author":"Lohman","year":"2002","journal-title":"Cancer"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1136\/bmj.332.7543.710","article-title":"Reconstructive surgery","volume":"332","author":"Boyce","year":"2006","journal-title":"BMJ"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"228S","DOI":"10.1097\/PRS.0b013e3182008e12","article-title":"Role of microsurgery in lower extremity reconstruction","volume":"127","author":"Engel","year":"2011","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1097\/01.prs.0000222224.03137.d5","article-title":"Revisiting the reconstructive ladder","volume":"118","author":"Turner","year":"2006","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.cps.2004.11.005","article-title":"Skin flaps","volume":"32","author":"Tschoi","year":"2005","journal-title":"Clin. Plast. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"147e","DOI":"10.1097\/PRS.0b013e3182910fba","article-title":"A practical guide to free tissue transfer","volume":"132","author":"Roehl","year":"2013","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1007\/s11999-011-2106-5","article-title":"Early complications of high-dose- rate brachytherapy in soft tissue sarcoma: A comparison with traditional external-beam radiotherapy","volume":"470","author":"Emory","year":"2012","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1055\/s-0032-1328919","article-title":"A paradigm shift in flap selection protocols for zones of the lower extremity using perforator flaps","volume":"29","author":"Hallock","year":"2013","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Lawrenz, J.M., Mesko, N.W., Marshall, D.C., Featherall, J., George, J., Gordon, J., Vijayasekaran, A., Nystrom, L.M., and Schwarz, G.S. (2020). Immediate Versus Staged Soft Tissue Reconstruction After Soft Tissue Sarcoma Resection Has Similar Wound and Oncologic Outcomes. Ann. Plast. Surg.","DOI":"10.1097\/SAP.0000000000002192"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1097\/01.blo.0000180450.21350.3e","article-title":"Vacuum-assisted wound closure after resection of musculoskeletal tumors","volume":"441","author":"Bickels","year":"2005","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1053\/j.oto.2014.02.011","article-title":"The BrachyVAC: A new method for managing sarcomas requiring soft tissue reconstruction","volume":"24","author":"McGough","year":"2014","journal-title":"Oper. Tech. Orthop."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1097\/SAP.0b013e31827c7973","article-title":"Predictive factors of wound complications after sarcoma resection requiring plastic surgeon involvement","volume":"71","author":"Sanniec","year":"2013","journal-title":"Ann. Plast. Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"841","DOI":"10.3892\/ol.2015.3289","article-title":"Clinical characteristics of patients with large and deep soft tissue sarcomas","volume":"10","author":"Nakamura","year":"2015","journal-title":"Oncol. Lett."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1097\/00003086-199304000-00038","article-title":"Wound complication in surgery of soft tissue sarcoma. Analysis of 103 consecutive patients managed without adjuvant therapy","volume":"289","author":"Saddegh","year":"1993","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1097\/BLO.0b013e3180514c50","article-title":"Soft tissue sarcoma resection volume associated with wound-healing complications","volume":"459","author":"Geller","year":"2007","journal-title":"Clin. Orthop."},{"key":"ref_53","unstructured":"Food and Drug Administration, HHS (2010). Medical devices; general and plastic surgery devices; classification of non-powered suction apparatus device intended for negative pressure wound therapy. Final Rule Fed. Regist., 75, 70112\u201370114."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1002\/jso.20485","article-title":"Lower extremity reconstruction","volume":"94","author":"Heller","year":"2006","journal-title":"J. Surg. Oncol."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/10\/4\/278\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:44:40Z","timestamp":1760179480000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/10\/4\/278"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,14]]},"references-count":54,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,12]]}},"alternative-id":["jpm10040278"],"URL":"https:\/\/doi.org\/10.3390\/jpm10040278","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,14]]}}}