The importance of the research in skin flap pharmacology is two-fold. First, observations made from the vasoactive drug actions in the vasculature of skin flaps can provide insight into the regulatory mechanism of cutaneous circulation and the pathophysiology of ischemic necrosis in skin flap surgery. Second, there is the possibility that the aforementioned information may eventually contribute to the development of a drug treatment for the augmentation of skin blood flow and viability in acute skin flaps (i.e., to mimic the surgical delay mechanism). To this end, the objectives of this article are: (1) to present a brief review of the recent research progress in the pharmacological treatment of ischemic skin necrosis in experimental flap surgery, and (2) to attempt to identify the future directions and important areas of research to be pursued in the pharmacology of skin flaps.