Bone loss due to congenital, tumoral, traumatic, or infection can be managed with a reasonable complication rate in upper extremity because vascularized fibula fits upper extremity bones in terms of geometry, size, and biomechanical characteristics. Flap in-setting is a very important step in reconstructive microsurgery; bone fixation is an essential part of the bone flap in-setting and may lessen potential complications. Bridge plating is the preferred technique, which offers good relative bone stability, almost always works very well, and prevents union problems. It should not be forgotten that reconstruction with vascularized fibula flap is a long process that requires patience on the part of the patient and the surgeon.