Soft tissue reconstruction techniques after musculoskeletal tumor resection: A systematic review of gastrocnemius flap, free flap, local flap, and orthoplastic reconstruction.

Despite widespread use, comparative outcomes across soft tissue reconstruction techniques for musculoskeletal tumor resection remain poorly characterized. A PRISMA-guided systematic review searched PubMed, Embase, Web of Science, Scopus, Cochrane Library, and Ovid MEDLINE from database inception through 30 June 2026. Ninety eligible studies were identified, evaluating gastrocnemius flap, free tissue transfer, local flap, and orthoplastic reconstruction. Reported limb-salvage rates exceeded 90% across all four reconstruction categories; gastrocnemius flap survival reached 94-100% and free flap survival 92-96%. Orthoplastic multidisciplinary planning was associated with lower wound complication rates. Technique selection should be individualized according to defect characteristics, radiation exposure, and institutional surgical expertise.