Oncologic resection of musculoskeletal sarcoma sometimes requires reconstruction with vascularized soft tissue transplantation. To date, few reports have described treatment outcomes of such cases. In the present study, 55 cases were enrolled to examine oncologic/functional outcomes, complications, and the risks for poor results. Five-year local recurrence-free survival, metastasis-free survival, and total survival rates were 83.0%, 87.6%, and 79.8%, respectively. In univariate analysis, bone origin was a risk for local recurrence. Local recurrence, inadequate margin, and trunk location were risks for metastasis, and inadequate margin and trunk location were risks for total survival. In multivariate analysis, local recurrence represented an independent risk for metastasis. The mean functional rating (Enneking) was 85.6%. Infection, distant metastasis, local recurrence, and prolonged operation time were risks for poor function. Use of artificial materials revealed a risk for infection. The results suggested that adequate margin and prevention of infection were critical to ensure excellent outcome.