Transfer of a FVFG is a technically demanding procedure. The principal indication for use of this method in the reconstruction of skeletal defects is the inappropri-ateness of simpler techniques, such as avascular bone grafting. Therefore, a defect of length greater than 5-6 cm, poor and avascular surrounding soft tissues and need for longitudinal bone growth are conditions, which warrant use of the FVFG. Distraction osteogenesis can also be considered in these cases. However, maximum length gained is up to 14 cm, duration of treatment is prolonged, complications are frequent and patient compliance is a critical factor. In addition, longitudinal soft tissue defects cannot be simultaneously addressed.

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