Autologous bone grafts are frequently employed for treating bone defects, with vascular and nonvascular options available. Typically, vascular grafts are favored for lower extremity defects exceeding 6 cm, while the use of vascular grafts in upper extremities lacks a clear size-defect correlation. Vascular bone grafts maintain microcirculation and osteocyte vitality, fostering callus tissue formation between the host and graft, and reducing resorption and infection risks compared to nonvascular grafts. Nevertheless, they entail longer surgery times and greater technical complexity. Geometrically placing pedicled grafts at recipient sites may prove less straightforward than nonvascular grafts. Vascular bone grafts can be categorized as osseous, periosteal, or composite based on their tissue content. Periosteal grafts serve as osteogenic membranes, suitable for small defects, nonunions, and avascular necrosis. Vascular grafts may be transferred free or pedicled, with pedicled grafts often sourced from the same limb, offering advantages like same-team preparation, shorter operative times, and the ability to operate under a tourniquet. However, they have limited bone availability compared to free grafts, preferred for extensive graft requirements. Pedicled bone grafts find applications in various upper extremity issues, including nonunions with avascular necrosis, post-trauma bone defects, osteomyelitis, tumor surgery, and congenital anomalies. Scaphoid nonunion is a common indication. Blood supply to vascular bone grafts depends on the donor site, with nutrient vessels, periosteal vessels, and nonpenetrating periosteal vessels serving as sources. Pedicled bone grafts follow a predictable arteriovenous support system and can be used antegrade or retrograde. Composite pedicle grafts may be employed for two-stage applications when blood flow is uncertain. Graft selection for upper extremity reconstruction depends on the recipient bone’s location, shape, and size, as well as structural requirements. The graft’s pedicle should be healthy, of adequate length, and possess an appropriate arc of rotation. Patient motivation and expectations, informed consent, and comprehensive medical records are essential considerations. This chapter outlines the key aspects of autologous bone grafts, emphasizing vascular options, their benefits, limitations, and various applications in upper extremity reconstruction.