This paper deals with bilateral vascularized fibular grafts (BVFG) as a method for reconstruction of metadiaphyseal defects of the femur and tibia in young patients suffering from malignant bone tumors of the lower limb. This reconstructional technique was used in 11 patients undergoing metadiaphyseal resection of lower limb malignant bone tumors. All patients with Ewing’s sarcoma and osteosarcoma had multimodal treatment according to the EURO-E.W.I.N.G 99 or COSS-96 protocol. Median FU was 63 months. None of the patients experienced local recurrence during FU. 2 patients died due to distant disease during FU. Full weight- bearing was permitted after a mean of 8 months. The median MSTS score was 87%. Complications occurred in five patients. None of the complications led to failure of the biological reconstruction or to amputation. Biological reconstruction of osseous defects is always desirable when possible and aims at a permanent solution. Good functional and durable results can be obtained by using BVFG for the reconstruction of metadiaphyseal defects of the femur and tibia. Radiotherapy in the multimodal setting increases the risk for graft or fixation failure. 1. Introduction The prognosis of patients with primary malignant bone tumors has improved within the last 30 years also due to the framework of standard therapy optimization studies (EURO E.W.I.N.G 99, COSS-96). In parallel, the proportion of limb-sparing resection and reconstruction procedures has increased steadily. More than 80% of patients can receive limb-sparing resection [1–4] without having an increased risk of local recurrence. The spectrum of reconstruction possibilities is extensive with options as tumor arthroplasty [3, 5–7], massive allografts [8–13], mantle grafts (massive allograft combined with a vascularized fibular graft [2, 14, 15] or irradiated autograft combined with a vascularized fibular graft [16–18]), and biological methods such as fibular grafts (vascularized/nonvascularized, unilateral/bilateral, “double barrel fibula”) [4, 19–28], tibial flake, pelvis flake, and callus distraction [12, 29, 30]. About 65% of primary malignant bone tumors are located in the lower extremities and near to a joint. In German speaking countries arthroplasty is the most common treatment in reconstruction of osseous tumor defects. The 10-year survival rate of endoprothesis is 55%–71% [3, 5–7]. Since it is mostly young patients, revision surgery should be expected in most cases of cured patients. Biological reconstruction techniques should be implemented whenever possible. The goal is a
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