The vascularized free myocutaneous flap graft, a recent advance in microsurgery, is a very useful reconstruction technique for covering massive soft tissue defects or muscular dysfunction caused by wide resection for malignant soft tissue tumors. We have used this technique to treat many patients after resection for malignant soft tissue tumors. Recently we encountered a case in which a malignant peripheral nerve sheath tumor (MPNST) metastasized to a vascularized free myocutaneous flap used for limb reconstruction surgery after wide resection of a primary lesion. To our knowledge, there have been no previous reports of metastasis of a malignant soft tissue tumor (or any other cancer) to a grafted cutaneous or myocutaneous flap.