Free vascularized fibular grafting-25 years' experience: tips, techniques, and pearls

Thirty years after its introduction vascularized fibula transfer remains an important tool for all surgeons dealing with particularly challenging bone reconstruction problems. It should be a consideration when simpler approaches either have failed or are expected to fail. It is particularly indicated for the reconstruction of massive bone defects associated with sepsis and bony non-unions associated with radionecrosis. The successful execution of vascularized fibular grafting, however, requires microvascular expertise and adherence to sound orthopedic principles for bone healing, including stable internal fixation, maximal bone-to-bone coaptation, and appropriate postoperative management regarding joint mobilization and weight bearing.