Vascularized bone grafting for talar avascular osteonecrosis is indicated for patients with modified Ficat and Arlet stage I to III disease with minimal subchondral collapse. Outcomes may be more durable than core decompression alone, especially in patients with more advanced disease. Our preferred method, described in this article, involves core decompression followed by use of a vascularized cuboid pedicle graft placed in the defect. Outcomes reported in a small case series have been encouraging, with more than 80% of patients requiring no further surgery.