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

Although my first attempt at free microvascular transfer of the fibula in 1979 could probably best be characterized as a traumatic event for both the patient and surgeon, over the ensuing 2-plus decades free fibula transfer evolved into my "best friend" for the management of especially challenging long bone defects and recalcitrant nonunions. This article is written from a rather parochial perspective of the author and in large part draws from personal opinions, experiences, and anecdotes. Also I should add that relatively few of the opinions and techniques described in this article are original-they are borrowed heavily from the experiences of my Mayo Clinic colleagues and pioneers in the field of free bone transfer, especially Alain Gilbert [1], James Urbaniak, Ian Taylor [2], and Fu-Chan Wei.