Multimodal therapeutic concepts in cancer therapy more and more often allow a curative approach even in advanced stages of the disease. Frequently, however, the radical resection of tumor tissue results in a significant defect of the soft tissue and the reconstruction is a challenge for reconstructive surgery. As tissue engineering for artificial tissue replacement predominantly still remains experimental, reconstruction of defects with autologous tissue constitutes state of the art treatment. Different types of flaps are used, which are, however, are accompanied by sometimes substantial defects at the donor site. To reduce donor site morbidity so-called perforator flaps represent an interesting option in modern reconstructive surgery. The flaps are raised without the underlying muscle which means a reduction of donor site morbidity to a minimum. As there still remains a residual risk for failure precise preoperative planning should be given a high priority. The use of modern imaging procedures, such as computed tomography (CT) angiography, can minimize the risk of total loss of the flap, making the use of perforator flaps a safe procedure in modern reconstructive surgery.