Limb salvage surgery is the standard care for most malignant tumors affecting extremities, and a vascularized fibula transfer is probably the most popular microsurgical option to reconstruct long-bone defects. In the last 10 years more than 80 patients underwent surgical treatment for bone tumor and primary microvascular reconstruction in a limb salvage treatment concept. Skletal reconstruction after bone tumor resection involving the metaphysis of a growing child can be successfully achieved with a vascularized fibula graft incorporating the proximal epiphysis and active growth plate. Successful transfer of the epiphysis requires modification of harvested fibula flap pedicle to include the anterior tibial artery. Such a procedure has been utilized in 3 children under the age of 11 years who had malignant bone tumors located in the upper limb, 2 in the distal radius, one in the proximal humerus. Two patients underwent distal radius resection for treatment of osteosarcoma, one case was treated for Ewing sarcoma of the proximal humerus. The mean bone defect was 11,8 cm. All grafts were supplied by the anterior tibial artery. The anastomosis of the tibial artery was performed in two cases in a retrograde fashion to provide pedicle length. In two cases nerve grafting and/or tendon transfers were performed. The wrist was stabilized with the remaining lateral collateral ligament and cast immobilization for 6 weeks. The mean follow-up was 16 months. The average growth rate of the grafts has been more than 1 cm per year. Radiographic exams showed a subluxation of the wrist in one case. The growth plate is open radiographically in all three cases. Growth plate transfer for reconstruction of distal radius or proximal humerus can be accomplished using the fibula and fibular head. Vascular supply in this case is supplied by the anterior tibial artery. This procedure offers a satisfactory skeletal reconstruction and prevents future limb-size discrepancy.