Upper extremity bone defects can occur as a result of trauma, nonunion, infection, tumor resection or avascular necrosis. Bone defects greater than 6 cm or complex defects may require free vascularized osteomyocutaneous flap reconstruction. Free vascularized fibula flap and deep circumflex iliac artery flap are well-known two flaps for extremity bone/complex defect reconstruction. The Iliac flap ensures large skin, muscle, and bone content, and variations of the vasculature are well-known and many modifications of the flap were defined. A deep circumflex iliac artery flap is one of the most suitable options with a free fibula flap, especially for distal upper extremity bone defect reconstructions.