To better understand skin flap research, three pivotal papers of the last decade are reviewed. The validity of Milton's questioning the accepted length to width ratio is confirmed, whereas the shunt theory of skin flap failure is rejected, and the value of isoxsuprine treatment for preventing flap failure is debated. Current trends in three other areas of skin flap research are highlighted—skin flap metabolism, skin flap monitoring, and the use of musculocutaneous flaps for contaminated wounds.