Since the first description by Hyakusoku in 1991, perforator propeller flaps have become one of the most commonly used method for defect reconstruction across the entire human body. We briefly reviewed the history, definition, nomenclature, and classification of perforator propeller flaps, and the corresponding surgical techniques were introduced in detail as well by reviewing our clinical cases. The clinical applications of the perforator propeller flaps were reviewed thoroughly by describing its use in different anatomic regions including the head and neck, trunk, extremities, buttock, and perineum respectively. Both the advantages and drawbacks of the flaps, common complications, and its prevention were also analyzed. Problems that we often encountered in the application of perforator propeller flaps and its current research status were analyzed and summarized. Although the perforator propeller flaps have been increasingly widely used, there still exist some important issues that deserve more concern and need to be solved, including precise perforator localization, accurate definition of perforators, correlations between the rotation angle of the flap, vascular patency and pedicle length. Though with the aforementioned problems, we believe that, like the tissue expansion and microsurgical flap transfer technique, the perforator propeller flap technique will ultimately become a conventional and important method for defect and organ reconstruction.