Objective To compare the effect of vascularized and non-vascularized fibula grafting performed for the reconstruction of bone defects after the resection of bone tumors. Methods Vascularized fibula grafting was performed in 18 patients with malignant or aggressive benign bone tumor of the extremities. Non-vascularized fibula grafting was performed in 15 patients with giant cell tumor of the radius. All the 18 patients were followed up with radiography, single photon emission computed tomography (SPECT), colored Doppler's sonography (CDS) examinations and functional observation for 2 to 14 years. Results Vascularized fibula grafts with bone defects of 9 to 26cm showed good blood supply in emission computerized tomography (ECT) and radiography examinations, and bone union was achieved (Table 1). In non-vascularized fibula grafting cases (Table 2), bone union was not achieved. Cconclusions The advantages of vascularized grafting are the feasibility of one-stage reconstruction of various tissues and the growth of grafted fibula. It is necessary to adopt vascularized fibula grafting to reconstruct large bone defect resulting from the resection of extensive bone tumors, such as giant cell tumor (GCT), fibrous dysplasia of bone and malignant bone tumors.