Introduction:
High energy injuries cause bone and soft tissue defects in the upper extremity. As it is known, free osteocutaneous fibula flap (FOFF) is an excellent option for treating the composite defects. In this study, we aimed to present the results of the metacarpal reconstruction with FOFF in hand defects due to gunshot injuries.  
Material and Methods:
Between the years 2006-2008, six patients with upper extremity gunshot injuries were treated with free osteocutaneous fibula flap. All patients had metacarpal bone and soft tissue defects and all flaps were transferred as an osteocutaneous fashion. Because of the size difference between fibula and metacarpal bone, we split the fibula before insetting the flap to the recipient area. In one patient, the flap was used in a double barrel fashion to reconstruct two metacarpal bone losses. Extensor tendon grafting operation was performed to two patients. Rehabilitation program was performed in the early period to all patients.
Results:
No postoperative complication was observed in three patients. In the remaining patient, partial necrosis of the skin island was occurred due to venous insufficiency and we revised the soft tissue in the second operation. Web releasing procedure was performed to one patient. The average follow-up period was 16 months. All flaps adapted well to the recipient area. All patients were found to have good hand function.
Conclusion:
Free osteocutaneous fibula flap is a safe and reliable option for treating complicated injuries of the upper extremity including metacarpal bone and soft tissue. It has an important role in reconstructive surgery, as it enables different procedures.