The perforator-plus flap is a new concept for lower extremity reconstruction. It combines a perforator flap with a traditional skin rotation flap. It can be another option for lower extremity soft tissue defects since the flap has an augmented blood supply. The ability to detect cutaneous perforators has improved with the Duplex scan imaging technique. These advances have made the perforator-plus flap a viable option for soft tissue reconstruction. It can be versatile and reduces donor site morbidity; it is technically simple to perform and faster than traditional free flaps. It achieves durable soft tissue coverage for lower extremity wounds.