<p>Mandible is a U-shaped bone which articulates with middle cranial base bilaterally with temporomandibular joints. Mandible poses as a fundamental component of facial aesthetics and oropharyngeal functions 1. Segmental continuity defects that are often encountered in the mandible after resection of cysts, tumor ablation or trauma, pose a challenge for reconstruction as they demand both functional as well as aesthetic rehabilitation. Gilbert and Taylor4 described the technique of harvesting the vascularized flap by anastomosing the skin pedicles with the regional vessels. This technique revolutionized maxillofacial hard tissue reconstruction. This article recapitulates our experience and highlights about indications as well as functional and aesthetic outcomes of using vascularized free fibula flap (FFF) for mandibular defects reconstruction over 10 years in our tertiary care center. A single tertiary centre retrospective study was conducted on 62 patients who underwent Osseo cutaneous free fibula flap (FFF) reconstruction for various mandibular defects from January 2014 to July 2024, all patients’ medical records were scrutinised for the demographic details, preliminary diagnosis, post operative&#xa0;Functional outcomes (FO) and complications. All patients were scrutinized for post operative outcomes for function and aesthetic at 1 year post operative so that the bias and complications associated with adjuvant therapy received is eliminated and tissues are atmost stabilized after healing. All data collected were, tabulated and were subjected to suitable statistical analysis. A total of 62 patients were included in the study of which 38 (61.3%) were male and 24 (38.7%) were female patients. The mean age group at which patient presented to us was 40.9 years (20–70 years). An average harvested fibula bone length was around 10.6 cms (range-5.5–21 cm) with skin paddle measuring an average 6.5 cm * 4.5 cm (range- 3.0 cm * − 4.0 * to 17 cm * 5.5 cm). All patients were scrutinized post operatively for function and aesthetic outcomes at 1-year, maximal mouth opening (interincisal range in CMS), mandibular movements range deficit, facial asymmetry, neural deficit (sensory and motor), swallowing and taste perception. 6 (9.6%) patients out of 62 patients developed post operative complications, with full or partial flap failure in 3 (4.8%) cases, surgical site infection in 1 (1.6%) case and scar complications in 2 (3.2%) cases which were managed conservatively. Vascularized Free fibula flap provides superior functional and aesthetic results with the advantage of rehabilitating large osseous defects. Hence optimal dissection, careful microvascular anastomosis (MA) techniques and good post operative care is the key to success for all reconstruction of mandibular defects using free fibula flap. This study also ascertained the viability of the bone graft and healing of the osteotomy site not being deterred by radiation therapy.</p>