Due to the development of perforator flaps, free flaps can now increasingly be elevated in smaller sizes. In fact, if the perforator flap is completely minimized, it would consist of only the vascular pedicle. We have succeeded in transplanting only the vascular pedicle with blood flow and have used this to create flaps in areas that lack vascular pedicles. These flaps are termed “secondary vascularized flaps,” and it is likely that they are successful because of the blood flow, which feeds the cells that constitute the transplanted vessels; after being transplanted, these cells then induce angiogenesis in the surrounding tissue, thereby establishing new blood flow to the area. This hypothesis is supported by the fact that when major vessels are extensively dissected during surgery and their ends are then ligated, the vessels do not necrotize.