Osteomyelitis is commonly observed in the pediatric population across sub- Saharan Africa. This 44-patient case series presents vascularized fibula flap (VFF) as a viable option for reconstruction of post-osteomyelitis defects of pediatric long bones in low-income countries. VFF achieves good radiological and functional outcomes, although postoperative complications are common. There was no recurrence of the bone infection in any of our cases. Further prospective studies are needed.