The implantation of massive cadaveric allografts is an increasingly common means of restoring skeletal integrity following resection of bone and musculoskeletal tumors. Unfortunately, the procedure has a high complication rate, ranging from 55-84%. Allograft failure can be a devastating complication and is a difficult reconstructive dilemma. The three most common complications following large allograft transplantation are infection, nonunion and fracture. The current study reviews the use of vascularized fibular grafts for limb salvage in cases of failed massive bone allografts. Methods: A retrospective analysis was preformed on all patients undergoing salvage of failed massive bone allografts over a 14 year period (July 1983-august 2001). Operative time, hospital course and post-operative complications were noted. Time to bony union was verified through radiographic evaluation. Results: Vascularized fibular grafts were performed in 22 patients who had failed allograft reconstruction. There were 15 male and 7 female patients with a mean age of 29 years (range, 13-46 years). The cause of allograft failure was nonunion in 14 patients, infection in 5 patients, and fracture in 3 patients. Of the 22 patients, 17 vascularized fibular grafts were performed as a primary procedure and 5 as a secondary procedure. The average length of the fibular graft was 20 cm. (range, 11-30 cm.). Of the 22 vascularized fibular grafts, 18 were free vascularized fibular transfers and 4 were pedicled fibular transfers. 3 procedures were combine with a muscle flap to provide additional soft tissue coverage to the area. Average operative time was 9 hours. The average follow-up time was 30 months (range, 6-13 mo.). Limb salvage was possible in 95% of patients (21 of 22). 32% of patient’s (7) developed a post-operative complication. 3 of these complications were related to secondary fractures in the allograft following vascularized fibular transfer. Bony union was achieved in 70% of cases (15 patients) after a single operation. 2 patients required a second free fibular transfer to achieve bony union. The union time between the fibular graft and the native bone or allograft ranged from 1.5-6 months with an average of 3.5 months. Conclusion: Excellent limb salvage rates are possible with the use of vascularized fibular transfer for failed massive allograft reconstruction. Vascularized fibular grafts should be considered as a primary means of limb salvage in these difficult reconstructive settings.