Objective To summarize the application, clinical value, and current limitations of venous superdrainage in perforator flap reconstruction. Methods The literature on venous superdrainage was reviewed, focusing on distal necrosis and venous outflow impairment in perforator flaps, the characteristics of the superficial venous system, the principles of venous superdrainage, and its application in different reconstruction sites. Results Venous superdrainage, by providing additional venous outflow channels to divert congested blood and reduce venous pressure, can significantly increase venous outflow of the flap (from approximately 4 mL/minute to 13.9 mL/minute in deep inferior epigastric perforator flaps). In breast reconstruction, selective anastomosis of the superficial inferior epigastric vein reduces venous congestion and related complications; in the distal lower extremity, prospective comparative studies of venous-supercharged propeller flaps and distally based sural flaps have shown significant reductions in venous congestion and distal necrosis. However, the benefits are influenced by individual venous anatomy and multiple factors, and identification of high-risk configurations and selection of target veins remain non-standardized. Conclusion Venous superdrainage has potential clinical value in certain high-risk configurations. However, its indications for prophylactic use, selection of target veins, and standardized implementation protocols require further clarification.