Folded free vascularized fibula transfer

A technique of improved free vascularized fibula grafting for bone defects up to 15 cm in length is presented with three illustrative cases. By dividing a harvested free fibula graft at its midpoint without dividing its vascular pedicle, two vascularized bone lengths are produced that require only one set of anastomoses. This folded fibula provides twice the cross-sectional area of a single fibula transfer and allows biomechanically improved graft placement. This technique has been successfully used in long bone defects of the upper and lower limbs.