Abstract This study included 25 patients with lower limb tumors who had reconstruction by vascularized fibula osteoseptocutaneous flap performed at least 24 months before the end of the study. Hypertrophy of the transplanted fibula was estimated on serial radiographs by a modification of the formula of De Boer and Wood (J Bone Joint Surg [Br] 71: 374–378, 1989). A significant graft was observed in 90% of the patients at an average follow-up of 27 months (range, 30–200%). The time to graft union (start of partial weight-bearing) positively ...