Background <p>Limb-sparing surgery and complex reconstruction of sarcoma defects is possible with advances in microsurgery and free flap reconstruction. We aimed to evaluate 10&#xa0;years of experience in free flap reconstruction of sarcoma defects at a tertiary referral centre.</p> Methods <p>A prospectively kept free flap database was reviewed for all patients who underwent free flap reconstruction for sarcoma defects over ten years. Data collected included demographics, comorbidities, components of resection, details of the reconstruction, complications, timing to radiotherapy and survival.</p> Results <p>From January 2014 to December 2023, 160 patients underwent 162 free flaps to reconstruct sarcoma defects. The mean age was 54.9&#xa0;years, mean BMI 26.9&#xa0;kg/m² and 59.8% was male (n = 98). The most common location was lower limb (45%), followed by head and neck (16.9%) and upper limb (15.9%). There was one flap loss (0.6%) and 13 (8.1%) microvascular complications. The highest risk area for complications was the chest; with 26.3% microvascular complication. Five cases had a functional reconstruction. The anterolateral thigh flap was the preferred flap used in all locations (52.4%). Myxofibrosarcoma was the most frequent diagnosis in this series (31%, n = 50). Clear margins were achieved in 87%. Adjuvant radiotherapy was given in 52%, on average 11.5&#xa0;weeks post-surgery. Sixteen percent (n = 26) developed a local recurrence and 29% (n = 46) distant metastasis resulting in 22% (n = 35) disease related death.</p> Conclusions <p>Free flap reconstruction has changed the potential for sarcoma reconstruction. The anterolateral thigh flap remains workhorse for reconstruction. We describe our experience and recommend tailoring reconstruction uniquely to the patient.</p> <p>Level of evidence: Level III, therapeutic study.</p>