Objective To summarize and discuss the key factors affecting the hemodynamics in the distal end of the multi-territory perforator flap, so as to provide a theoretical basis for the follow-up research and clinical application in this field. Methods The related recent literature about multi-territory perforator flaps was extensively reviewed, and the concepts and researches of perforasome, choke vessel zone, arterial super-charge, and venous super-drainage were summarized. Results The multi-territory perforator flap is composed of multiple perforasomes, and there are different types of vascular anastomosis in the choke vessel zones, which have important impacts on the hemodynamics of the flap. In order to ensure the survival of the multi-territory perforator flap, arterial super-charge and venous super-drainage are mainly used in clinical practice. However, no consensus has been reached on the choice of the two techniques. The different distribution of blood vessels in the flap, the number of perforasomes, and the type of vascular anastomosis may be the main reasons for the different results. Conclusion The location, diameter, and axial characteristics of perforators, the number of perforasomes, and the type of vascular anastomosis are the key factors affecting the hemodynamics of the multi-territory perforator flaps, which should be paid attention to in preoperative design and surgical procedure.