<p>A perforator flap is a minimally invasive option that does not compromise major blood vessels. However, the position and the course of the perforator vary from person to person, making the design of the flap difficult. In addition, negative pressure wound therapy (NPWT) is used not only for open wounds but also for management after flap surgery. We report the case of a 50-year-old woman who underwent total elbow replacement for a pathological fracture of the distal right humerus. One month after the operation, dehiscence of the suture wound was observed. The prosthesis was exposed from the wound. A perforator flap operation was planned to cover the prosthesis. Indocyanine green fluorescence angiography was performed to identify perforators. The flap was designed in the running direction of the perforator. After the operation, exudate from the edge of the skin flap appeared and persisted. Seventeen days after the flap surgery, we decided to perform negative pressure wound therapy for the purpose of managing exudates. After confirming that the drainage in the canister gradually decreased and disappeared, the therapy was terminated on the 41 st day after flap surgery. Intraoperative ICG fluorescence angiography in perforator flap surgery is useful for flap design by identifying the location and the running course of perforators. Additionally, NPWT after flap surgery contributes to the reduction of exudate while enabling early rehabilitation. A combined use of these techniques allows safe and reliable covering of an exposed prosthesis.</p>