The lunate serves as a conduit for blood flow to the wrist via the palmar and dorsal arches. Although there are various opinions on how lunate avascular necrosis develops, vascular disruption is considered to be the main cause. Once osteonecrosis has developed, interruption of the insidious osteoclast-dominated substitution process provides more appropriate revascularization in treatment. For this reason, the use and selection of vascular bone flaps are of utmost importance. In particular, the use of pedicle flaps, such as four to five extracompartmental arterial flaps, leads to good results. In addition, the use of free osteochondral flaps in cases involving the proximal articular surface of the lunate after osteonecrosis has limited the indications for salvage surgery and resulted in positive patient outcomes.