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