Spinal reconstruction is a growing field, with innovations including multidisciplinary teams comprised of orthopedic, plastic, and neurosurgeons. Vascularized bone grafts (VBGs) are pedicled on local muscle, with their bony segments perfused by Sharpey’s fibers to provide superior osteogenesis compared to nonvascularized alternatives. The iliac crest, rib, spinous process, scapula, occiput, and clavicle are each viable sites for VBG harvest depending on the level and size of the defect targeted for augmented spinal fusion. While reconstructive spinal surgery can often be complex and challenging, VBGs are a prime example of surgical innovation, collaboration, and team-based care to improve patient outcomes.