In sarcoma surgery besides a wide local resection, limb salvage became more and more important. Reconstruction of bone and soft tissue defects after sarcoma resection poses a major challenge for surgeons. Nowadays a broad range of reconstructive methods exist to deal with bony defects. Among these are prostheses, bone autografts, or bone allografts. Furthermore a variety of plastic reconstructive techniques exist that allow soft tissue reconstruction or coverage after sarcoma resection. Here we discuss the historical highlights, the present role, and possible future options for biological reconstruction. 1. Introduction Bone and soft tissue defects after sarcoma resection pose a major challenge for surgeons [1]. While in animal life the regeneration of whole extremities is possible in some species such as starfish [2] or salamanders (Figure 1) [3, 4], in humans surgeons are dependent on advancement and innovations in biological and mechanical reconstruction. In sarcoma surgery besides a wide local resection, limb salvage became more and more important [5]. Mechanical stability and strength and the possibility of reattachment of tendons and ligaments are necessary to achieve motion and good function in reconstructed limbs. Various methods and techniques have been developed and optimized that allow maintaining the function of the extremity. To achieve this, bony defects can now be reconstructed with prostheses, bone autografts, or bone allografts. Furthermore a variety of plastic reconstructive techniques exist that allow soft tissue reconstruction or coverage. Additionally different factors are studied that might promote graft incorporation and bone repair. The aim of this review is to give an overview of historical highlights, the present role of bone grafts, and possible future options for biological reconstruction. Figure 1: Axolotl or Mexican salamander ( Ambystoma mexicanum), one of the few species that maintains the ability to regenerate its tail or limbs throughout its life. Karol G？？b/Wikipedia Creative Commons. 2. Past The first evidence of human bone allografts in medical literature can be found in a paper published by MacEwen in 1887 [6]. The outcome of this method used in four nononcological cases was published in Annals of Surgery in 1909 [7]. One of the first cases which was treated in 1874 was a three-year-old boy with an osteomyelitis of the right humerus. The necrotic bone was removed surgically resulting in a deformed and useless humerus after a fifteen-month of followup. The boy’s parents wanted MacEwan to have the boy’s arm amputated.
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