Simple SummarySoft tissue and bone sarcomas are a diverse group of aggressive tumors. Lately, the shift in their management, with an emphasis on limb salvage, has deemed the involvement of reconstructive surgeons an integral part of their multidisciplinary treatment. We present our experience with 90 free and pedicled free tissue transfers in the reconstruction of sarcomas at a major sarcoma center over a 5-year period: diabetes, alcohol consumption and male gender were associated with increased wound healing problems, preoperative chemotherapy significantly increased the occurrence of early infection, while preoperative radiotherapy was associated with a higher incidence of lymphedema. Reconstructive surgery with either pedicled or free tissue transfer after sarcoma resection is reliable, but a higher complication rate is to be expected with neoadjuvant therapy and with certain comorbidities.AbstractBackground: Soft tissue and bone sarcomas are heterogeneous groups of malignant tumors. The shift in their management, with an emphasis on limb salvage, has deemed the involvement of reconstructive surgeons an integral part of their multidisciplinary treatment. We present our experience with free and pedicled flaps in the reconstruction of sarcomas at a tertiary referral university hospital and major sarcoma center. Materials and Methods: All patients undergoing flap reconstruction after sarcoma resection over a 5-year period have been included in the study. Patient-related data and postoperative complications were collected retrospectively, ensuring a minimum follow-up of 3 years. Results: A total of 90 patients underwent treatment with 26 free flaps and 64 pedicled flaps. Postoperative complications occurred in 37.7% of patients, and the flap failure rate was 4.4%. Diabetes, alcohol consumption and male gender were associated with increased early necrosis of the flap. Preoperative chemotherapy significantly increased the occurrence of early infection and late dehiscence, while preoperative radiotherapy was associated with a higher incidence of lymphedema. Intraoperative radiotherapy was associated with late seromas and lymphedema. Conclusions: Reconstructive surgery with either pedicled or free flaps is reliable, but it can be demanding in the setting of sarcoma surgery. A higher complication rate is to be expected with neoadjuvant therapy and with certain comorbidities.