The lower extremity is the most common location of soft tissue sarcoma (STS) [1, 2]. Unlike the upper extremity, there is often more local soft tissue available for soft tissue reconstruction after tumor resection. Similarly, due to the advent of modern radiation therapy techniques (see Chap. 13 ), preoperative radiation allows the surgical team to perform “close margin” resection utilizing fascial margins which often renders neurovascular structures viable [3]. Additionally, radical excision with amputation has not shown to improve overall survival [4]. As such, limb salvage is often attainable following STS excision and has become the primary treatment for extremity STS [5–7].