Soft Tissue Sarcoma with Lower Limb Impairment: Development of a Specific Rehabilitation Protocol Based on Demolitive and Reconstructive Surgery Types

<b>Background/Objectives:</b> Soft tissue sarcomas (STSs) are extremely uncommon tumors with a high rate of local recurrence that often require very demolitive surgery. The aim of our study is to propose a specific rehabilitation protocol for patients with STSs, based on the kind of demolition and reconstructive surgery performed, and evaluate its effects. <b>Methods</b>: The protocol was developed on the basis of the clinical experiences of physiatrists and surgeons, as well as data from the literature, recommending timelines for postural steps, verticalization, walking, and therapeutic exercises, in accordance with wound healing times and in order to prevent complications from disuse and immobility. The modified Barthel Index Scale (mBI), the Numeric Rating Scale (NRS), the Adapted Patient Evaluation Conference System (APECS), and the 10 Meter Walk Test (10 MWT) were used to clinically evaluate patients before and after the rehabilitation treatment. <b>Results</b>: Thirty-one patients with primary STSs were enrolled. Following the rehabilitation program, we found a statistically significant improvement in mBI (<i>p</i> < 0.001), APECS (<i>p</i> ≤ 0.001), and NRS (<i>p</i> = 0.001). In a subgroup of patients (<i>n</i> = 18) assessed with the 10 MWT, a statistically significant increase in walking speed was observed (<i>p</i> = 0.012). <b>Conclusions</b>: Patients who completed rehabilitation following the proposed protocol, customized according to the surgical intervention type, demonstrated marked improvements in motor performance, ability in daily activities, walking, and pain. The proposed protocol can assist the multidisciplinary team of surgeons, oncologists, and rehabilitators in maintaining alignment on patient management, thereby ensuring clear indications regarding the activities that patients can and cannot undertake during the recovery period.