Transplantation of vascularized bone flaps based on microsurgical techniques in treat-ment of osteonecrosis of the femoral head(ONFH)involves microsurgical anastomosis of crucial ves-sels to maintain blood supply to the femoral head following neck fractures,thereby reconstructing cir-culation,promoting healing of the necrotic areas,preventing articular surface collapse,and providing biomechanical support.This review summarized the research progress of treating ONFH with microsur-gical techniques for vascularized bone flap transplantation,exploring the effectiveness and importance of microsurgical techniques in managing femoral neck injuries and subsequent ONFH,offering new in-sights into treatment of femoral neck fractures and ONFH.