Local tumor control treatment of soft tissue sarcomas (STS) has historically consisted primarily of surgery and radiotherapy. Nowadays, increasingly systemic therapy has begun to play a role in treatment, especially with the advent of targeted therapies. Positive margins after surgical resection are associated with an increased risk of local recurrence. Therefore, re-resection is preferred until negative margins are achieved. In the case of recurrent sarcoma unsuitable for surgical resection with wide and clear margins, a multimodality treatment should be applied. Sarcoma recurrence in patients receiving neoadjuvant therapy before surgical resection is one of soft tissue tumors` most complex management challenges. Multimodality management of recurrent extremity soft tissue sarcoma depends on previous treatments. Therefore, any information regarding their previous treatment should be available in detail. The treatment options we have; generally, radiotherapy, systemic chemotherapy, chemo-radiotherapy, and surgery, all these strategies provide benefits, but they also carry certain risks. While the role of adjuvant therapies is being explored, adequate surgery remains the cornerstone of multimodality treatment. Amputation can provide local control and symptom relief for recurrent limb soft tissue sarcoma. Regional chemotherapy applications in the form of hyperthermic isolated limb perfusion or isolated limb infusion may be an additional limb salvage treatment option in the treatment of recurrent limb STS. Early referral of these complex patients to a multidisciplinary regional sarcoma center specializing in soft tissue tumors is strongly recommended in cases of local recurrence.