Local flaps are established procedures for reconstruction of skin and soft tissue defects. Although a cutaneous flap (the so-called Indian flap) had been applied more than 2000 years ago for reconstruction of nasal defects, axial pattern skin flaps for applications in reconstructive surgery were mainly developed in the second half of the twentieth century. Detailed knowledge of the vascular anatomy of the skin eventually led to development of a novel type of skin flap that entirely relies on perforating vessels. In the beginning these so-called perforator flaps were mainly used as microsurgical free flaps. However, the same concept also allows for safe and efficient transfer of large tissue volumes into given defects as a local pedicled flap. This article describes different technical aspects of local perforator flaps and provides examples for clinical applications in different regions. Specific Indications and contraindications of local perforator flaps are discussed in detail.