Purpose: This retrospective study aims to report an algorithm to assist surgeons in selecting different modes of the double barrel vascularized fibula graft for mandibular reconstruction.Methods: Forty-five patients who underwent reconstruction of mandibular defects with different modes of the double barrel vascularized fibula graft were reviewed.Our algorithm for deciding on any one of the different modes for different mandibular defects is influenced by the factors including history of radiotherapy,the length of mandibular body defect,and the need to preserve the inferior mandibular border.Postoperative functional outcomes included diet type and speech,and aesthetic results gained at post-operative 2 years.Patients with implant-borne prosthetic teeth underwent assessment of their masticatory function.