Hyakusoku et al. [1] introduced a propeller flap for reconstructing the axilla and cubitus in 1991. Initially, the original propeller flap was used for intact fossa and was designed as a subcutaneous pedicled island flap. Since then, this flap has undergone significant refinement, leading to the development of various types of propeller flaps [2–11]. The most notable evolution is the perforator pedicled propeller (PPP) flap [5], which has become an essential option in the use of perforator flaps. The use of an eccentric perforator pedicle (Fig. 59.1a) enables a 180° rotation [6, 7], allowing it to cover defects over longer distances (Fig. 59.1b).