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Objective: To study the effect of vascularized fibular graft on large defects of long bones and the monitoring method for the vascular status of the grafted fibula.Methods: From March 1988 to February 1998, 30 patients with long bone defects over 6 cm in length received vascularized fibular graft including a monitoring island flap in our department to monitor the blood circulation of the fibulae.Results: Monitoring island abnormalities were indicated in 6 flaps, which accurately gave the alarm of the circulation crisis of the fibular graft.Surgical exploration was performed timely and the blood supply was recovered instantaneously.All the bone defects were healed at 6 months postoperatively.After 4 years of follow-up, all the grafted fibulae were thickened and were just like tibiae.Conclusions: A monitoring island flap is a satisfactory method for repairing large defects of the long bones and a reliable method for assessing the vascular status of the grafted fibulae.