Perforator flaps have revolutionized reconstructive surgery by enabling reliable tissue coverage while significantly reducing donor site morbidity. Based on the use of small-caliber perforating vessels, these flaps allow the transfer of cutaneous and subcutaneous tissues without sacrificing muscle. Advances in the understanding of vascular anatomy and the use of preoperative imaging—particularly Doppler ultrasound and CT angiography—have enabled precise planning and safe dissection. Numerous variants have been developed, including deep inferior epigastric perforator (DIEP) flaps, anterolateral thigh (ALT) flaps, gluteal perforator flaps, and freestyle flaps, each with specific indications and advantages. The emergence of supermicrosurgical techniques, particularly perforator-to-perforator anastomoses, has expanded reconstructive options, especially for distal or complex tissue defects. This article provides a review of the principles, technical aspects, and clinical applications of perforator flaps, highlighting their central role in modern reconstructive surgery.