This study included 11 patients with lower limb tumors who had wide local resection and reconstruction by vascularized fibula osteoseptocutaneous flap and their surgery performed at least 24 months before the end of the study. The average age at operation was 14.4 years. All tumors, except one, were high-grade sarcomas (stage IIA, IIB, and Ewing's sarcoma). The tumor volume averaged 200.6 cm3 (range 41.5-400). The resulting defect after tumor resection averaged 14.8 cm (range 9-20). The fibula was inserted as a single strut in eight patients and as a double-barrel construct in three patients. Fixation was augmented by interlocking nail in four cases, bridge plate in five cases and external fixator in two cases. All flaps survived. All grafts united in an average period of 3.9 months (range 3-8) after transfer. Full weightbearing was possible after an average period of 6 months (range 6-10). Significant hypertrophy (>/=30% of the original fibular diameter) occurred in all patients after an average period of 10 months from the index operation. In the latest follow-up radiographs (mean 38 months), the degree of hypertrophy averaged 96.6% (range 30-200%). Graft fracture occurred in one patient after plate removal and healed conservatively. Shortening averaged 1 cm (range 0-3). The Musculoskeletal Tumor Society rating score averaged 21 points at the end of the first postoperative year and 23 at the end of the study.