In Nonunions, the case in which a broken bone fails to heal in an acceptable period of time, alternative treatments to immobilization alone are considered.  Occassionally, when this happens, a new blood supply may need to be brought in to aid the healing process.  Vascularized bone grafts include bone donor sites near to or remote from the area for repair.  Scaphoid fractures are the most notable example in the wrist, especially those of the proximal pole, the part nearest the forearm.  Avascular necrosis of the lunate, Kienböck’s Disease, often require a surgical procedure, such as a vascularized bone graft, in order to heal.  Traumatic bone loss and tubular bones of the upper extremity, from the metacarpals to the humerus, may be considered for this form of surgical reconstruction.