Large diaphyseal defects of long bones after post-infective sequestration continue to be a challenge for the surgeon. Chronic osteomyelitis and persistent sepsis often result in loss of diaphysis of long bones, more so in children. It may follow massive segmental bone death, wrongly timed sequestrectomy or a radical bone debridement (Figs. 8.1a–g and 8.2a–e). Such a situation is also associated with severe fibrosis and poor vascularity in the soft tissue envelope. This makes the tissues less pliable and the graft take may be more difficult (Figs. 8.3a–c and 8.4a–g). In severe bone loss, the options lie between reconstruction and even amputation. The modalities for reconstruction vary and include the use of non-vascularized graft and vascularized bone graft. The construct also offers a better mechanical advantage for early and dependable union and remodelling. Twin fibular grafts not only provide added graft volume but also help in better host-graft fixation (Figs. 8.5a–d and 8.6a–e). Stable fixation creates a better physiological condition at the host-graft junction, resulting in early lateral union, and minimizes the period of immobilization of the extremity.