Segmental long bone defects greater than 6cm in the upper or lower extremity have been reconstructed with intercalary allograft or vascularized bone grafts or a combination of both in limb salvage procedures after tumor resection. The combination of these grafts has lead to a discussion regarding the contribution of the vascularized bone graft to the healing process of the allograft and union at the proximal and distal ends of the segmental defect. Vascularized bone grafts have been placed adjacent to allografts or hemi-allografts. To accelerate bone healing the vascularized graft should be positioned and shaped to maximize the delivery of nutrients, osteogenic cells and growth factors along the allograft and at the allograft/native bone interface. Furthermore, the construct must provide compressive and tensile strength across the defect to promote early ambulation and accelerated healing at the proximal and distal ends of the defect. We present an 18 year old female with an 8 cm osteosarcoma of the right distal femur. Resection resulted in a 14 cm defect with preservation of 4 cm of distal femur and the knee joint. Reconstruction was performed using a combined allograft/vascularized fibula flap construct such that the free vascularized fibula flap was inserted through the central portion of the allograft with 3 cm of the fibula extending past the allograft proximally and 1.5 cm distally. The pedicle traversed the allograft through a 1 cm trephine in the middle 1/3 of the wall of the allograft. Microvascular anastomosis was performed to the local branches of the superficial femoral artery and Vein. Three months post reconstruction the patient is non weight bearing. Her active range of motion at the knee is 15-90 degrees and passive range of motion is greater than 90 degrees. Radiographs of the defect revealed distal and proximal alignment with little callus formation. Early results of this combined constructed has demonstrated a stable, well aligned repair of the defect with promising healing characteristics in limb salvage surgery for large segmental long bone defects.