The treatment of Preiser’s disease remains controversial. Multiple treatment options have been suggested. Recently vascularized bone grafts (VBGs) have been used successfully for the treatment of scaphoid non-unions and Kienbock’s disease. The purpose of this study is examine the outcome of VBGs for the treatment of Preiser’s disease and to make recommendations for treatment based on the stage of presentation. Over a nine-year period (1992-2002), 8 pedicled VBGs were performed as treatment for Preiser’s disease. Average patient age was 41 (31-61). All patients had pre-operative MRI confirming the diagnosis of avascular necrosis of the scaphoid prior to surgery. All patients underwent a reverse-flow pedicled VBG from the distal radius, based upon the described anatomy. Concomitant unloading procedures were used in 2 of the 8 cases. Mean follow-up was 17 months. Post-operative evaluation included range of motion, grip strength, pain evaluation, and Mayo wrist scores. Radiographic evaluation included measurements of carpal height, scapholunate angle and post-operative changes in the MRI. Wrist motion averaged 52% of the unaffected side following surgery. Grip strength remained stable. 88% of patients had improvement in pain. Mayo wrist scores averaged 65, with 4 patients rated as good, 3 as fair and 1 as poor. 6 of the 8 patients had follow up MRIs at a mean of 6 months post-operatively. All MRI’s showed evidence for revascularization, with improvement in T2 and/or T1 signal, however a consistent finding on MRI was the inability to revascularize the proximal pole. There was one frank reconstructive failure resulting in a PRC less than one year after the surgery. Radiocarpal arthritis was present radiographically in 50 % of patients at final follow up. In this series VBGs did provide an improvement in patients pain and preserved radiocarpal wrist motion in the majority of patients. All patients were able to avoid wrist fusions. Inability to revascularize the proximal pole of the scaphoid and ongoing wrist arthritis appear to persist despite revascularization attempts. Vascularized salvage of Preiser’s patients should be limited to early cases without evidence of radiocarpal arthritis and no evidence of carpal instability. Otherwise, scaphoid excision with midcarpal fusion or PRC is recommended.