This study evaluated the clinical and radiographic results of 44 patients (26 men and 18 women) who underwent reconstruction of large defects of the long bones with free vascularized bone grafts. Mean patient age was 29+/-15 years and mean follow-up was 8.6+/-2.1 years. Mean Enneking index was 78.6% (95% confidence interval, 73.8-83.4). No differences were noted for different types of graft, etiologies, or anatomic locations. Regression analysis revealed no association between defect size and functional results. Sixteen patients developed 29 complications. All but 1 patient showed full incorporation of the graft. These results confirm the value of vascularized grafts for bridging large bone defects.