Soft tissue defects around the elbow are a real challenge in the field of reconstructive surgery. This anatomical region is passed by superficial noble anatomical structures (arteries, veins, nerves) that are often exposed in post-traumatic or post-excisional defects. The elbow joint has a high tendency to stiffness or ankylosis even after short immobilization. The pedicled perforator flaps, based on source vessels from the anastomotic arcades of the elbow seem to be an efficient and reliable reconstructive choice. The flap offers a good local coverage, replacing "like with like", has minor donor site morbidity and contrary to the free flaps, allows the very early beginning of physical therapy starting with the first postoperative day. This paper represents a review of the literature concerning this problem.