Sarcomas in the forearm and hand are very rare, and surgical outcomes have been unclear. The aim of this study was to examine oncologic outcome, microvascular reconstruction, and functional evaluation. A retrospective review was performed in 19 patients who were treated for soft tissue or osseous sarcoma. All 12 patients with sarcoma in the forearm were treated with limb salvage and needed microvascular reconstruction. Flap survival was excellent. Local recurrence occurred in 4 patients, 3 of which had previously undergone inadequate resection. Three patients had distant recurrence and 1 died of disease. The mean Enneking functional score was 83% at a mean follow-up period of 37 months. Although sarcomas often metastasize, the overall survival rate is excellent. Wide marginal resection during initial surgery is the most predictive factor for tumor control. Microvascular cutaneous, myocutaneous, or osteocutaneous flap reconstruction is essential for limb salvage and provides reliable, safe coverage with reasonable preservation of function.