The first microvascular bone transfer was performed by Taylor and coworkers, who used a vascularized myoosseous segment of the fibula to treat a posttraumatic defect of the tibia in 1975 [530]. Since this first description, the primary indications for the fibular bone flap have been reconstructions of extended bone defects in the extremities by using a posterior approach for flap harvesting, which was originally described by Taylor et al. [530]. Whereas these first transfers of the fibula have been performed without including a skin paddle, Chen and Yan were the first to report about an osteocutaneous fibula flap in 1983 [87]. This extension of flap raising became possible following the proposal of Gilbert to use a lateral approach for harvesting the bone flap, which was easier to perform and allowed for visualization of the cutaneous branches of the peroneal artery [166]. A valuable extension of the indicational spectrum of the fibular flap was achieved by Hidalgo, who in 1989 performed the first lower jaw reconstruction using osteotomies to mimic the shape of nearly a whole mandible [216].