Aim: During the last 9 years we have used a total of 77 free osteofasciocutaneus fibula flaps in several clinical cases such as: 52 neophallus constructions by female-to-male transsexuals, 21 composite mandible reconstructions (after tumor surgery or osteoradionecrosis), as well as 3 lower leg and 1 forearm reconstructions for oncologic surgical defects. Material & Methods: In order to evaluate the utility of these flap we analyze the security of these flaps in relation to the magnitude of the used skin paddle and the fibular length, as well as to the pedicle length, the position and number of the osteofasciocutaneous branches of the peroneal artery, and the modifications performed during flap harvesting and its fixation to the recipient-site. Additionally we examined their donor-site morbidity. Results: We observed that exists a great security of the blood supply also by large skin paddles although some of these flaps undergone massive modelling of their soft tissue and bony part by the various clinical apllications.The donor-site morbidity was moderate. Conclusions: The utilization of the free osteofasciocutaneous fibula flap is one of the best possible therapies for difficult composite reconstructions. It provides a long, broad and strong bicortical bone of excellent quality that supports physical stress and offers good intrinsic rigidity for neophallus construction, a periosteal blood supply that allows multiple osteotomies, a long vascular pedicle with large vessels, and almost constant anatomy. In addition, the skin paddle has an uniform medium thickness, and is sufficiently large and pliable, ideal for reconstruction of associated soft tissue defects. The donor-site morbidity is relatively insignificant. For these reasons we do further support the widespread utilization of this flap for the reconstruction of composite defects.