* Preclinical animal studies have demonstrated that vascularized bone grafts increase blood flow, maintain patent pedicles, provide immediate structural integrity, hypertrophy in response to mechanical stress, and deliver proper environments for healing in challenging situations. * The absolute indications for vascularized bone graft as borne out by high-quality studies have yet to be defined. Currently, the literature suggests varying success rates for difficult reconstructive problems requiring additional biological and structural properties offered only by vascularized bone-grafting. * Orthopaedic reconstructive challenges can be met with a variety of options, including pedicled and free vascularized bone grafts.