Purpose: Local resection with or without irradiation is the primary treatment modality of soft tissue sarcomas. Adequate surgical margin is required for local tumour control and avoiding local recurrence. Adjacent bone should be included into the resection plan if the tumour is in the close proximity of the bone or cortical and medullary tumour invasion was present. Reconstruction method depends on the location.

Methods: 25 patient (10 female, 15 male) with soft tissue sarcomas received local wide excision including adjacent bone between 1995–2007. Histological types were 3 MPNSTM, 3MFH, 10 Synovial sarcoma, 2 liposarcoma, 4 angiosarcoma, 2 fibrosarcoma, 1 Leiomyosarcoma. Localisations were 5 glutea, 9 thigh, 5 cruris, 1 forearm, 5 foot. In 8 patients with proximal bone resection including the joint surface prosthetic reconstruction were aplied. 6 Patients with intercalary resections required allograft reconstruction with I.M nail, 2 patients required autoclaved graft, 1 patient needed tricortical iliac autograft. 8 patients in the gluteal region required iliac and sacral resections without any bony reconstruction. 25 patient received irradiation. 16 of them had neoadjuant chemotherapy also.

Results: At mean 64 mo.s follow up (min11–max159). Mean age was 44, 5 (min 18–max 71). Oncologically 17 patients were NED, 1 AWD, 7 DOD (2 with local recurrence). Regarding complications 7 patients developed local recurrence, 2 patient developed infection, 2 patient had developed wound healing. 5 of 7 local recurrences were amputated. 2 of them died of the disease. 2 local recurrences could be re-resected. Delayed wound healing and infection occured in the patients received preoperative chemotherapy and irradiation.

Conclusion: If a large soft tissue sarcoma is in the close proximity of an adjacent bone or had cortical or medullary invasion, adjacent bone must be included in the resection plan so that a wide margin could be achieved. Reconstruction of the created bone defect in the weight bearing bone close to a major joint should be prosthetic reconstruction. Allograft reconstruction is recommended in the foot and upper extrimity. A thorough preoperative plan with appropriate imaging should be done and local resection should be performed precisely to achieve satisfactory wide margin which influences the both local and systemic outcome.

Proximal humerus is the common site for primary bone malignancies that surgical treatment consists of wide excision of the tumor and reconstruction with tumor resection prosthesis or allograft. The ultimate function of the shoulder depends on the degree of sacrification of adjacent structures. Thirty-two patients with primary malignancies have been treated by wide excision and endoprosthetic replacement by senior author between 1989–2005 12 patients were female, 20 patients were male, mean age was 26,6 years (range 7–69 years). Histological diagnosis was 14 osteosarcoma, 4 Ewing’s sarcoma, 4 chondrosarcoma, 3 parosteal sarcoma, 4 giant cell tumor, 1 aneurysmal bone cyst, 2 synovial sarcoma. Synovial sarcoma, osteosarcoma and Ewing’s sarcoma patients received neoadjuvant chemotherapy prior to excision. Mean follow-up was 50,4 months (range 6–153 months). Oncologic results were 20 patients NED (no evidence of disease), 2 patients AWD (alive with disease), 10 patients DOD (died of disease). Functional outcome was scored according to Musculo-Skeletal System Tumor Society (MSTS) rating scale, 7 patients were excellent, 22 patients were good and 3 patients were poor. Regarding complications 2 patients developed local recurrence, 2 patients had superficial infection. Infected cases were treated by systemic antibiotic treatment. All patients had dexterity of the hand and elbow. Regarding shoulder abduction and forward flexion, 7 patients whose deltoid muscle and axillary nerve could be spared got nearly normal shoulder function but even the patients with loss of deltoid had limited abduction owing to elevation of scapula by shrugging. Elongation of the newly formed shoulder capsule was seen in patients that artificial mesh augmentation was not used. Prolene mesh was used to create a new substitute instead of resected shoulder joint capsule. These patients did not show any elongation at long-term follow-up. All arthroplasties was hemi-type without glenoid reconstruction. Hemiarthroplasty by a modular tumor resection prosthesis system after wide excision of proximal humerus seems to be an effective method of treatment after shoulder malignancies. The main determinant of the function is the status of deltoid axillary nerve and rotator cuff but the patients deprived of structures had a functional upper limb with a good command of the elbow and the hand.