The results and complications of lower extremity bone reconstruction using microvascular fibula transfer were retrospectively compared with reconstruction using microvascular iliac crest transfer, Seventeen patients matched as much as possible in regard to location of defect (femur, tibia, ankle) and aetiology (traumatic defect, osteomyelitis) were studied in each group. Data collected included number of prior operative procedures, length of bony defect, presence or absence of associated soft tissue loss, the final clinical and radiographic result, technique of bone immobilisation and duration to union, complications including patency of microvascular anastomoses (if known) and nature and number of additional operative procedures. The outcome of this study suggests that, for reconstruction of the femur or tibia bridging a defect greater than 10 cms, fibula transfer yielded a satisfactory outcome. For defects less than 10 cms resulting from debridement for osteomyelitis, iliac crest transfer yielded a more favourable result. Moreover, the iliac crest appeared to be more optimal than the fibula for reconstruction about the ankle regardless of aetiology. (C) 1996 Wiley-Liss, Inc.