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When a perforator flap is transposed in pedicled fashion, twisting, tension, or both can be inflicted on the pedicle. Although high density twisting undoubtedly decreases flap survival, the effect of pedicle tension with or without twisting has not been studied for perforator flaps. The authors designed a model of nonanastomotic pedicle tension using a cranial epigastric perforator flap in rats. Sprague-Dawley rats were divided into 4 groups—control, twist, tension, tension plus twist groups; each group consists of 10 rats. Tension group had lower flap survival ratios than control and the flap survival ratio of tension plus twist group was lower than those of the other groups (p < 0.05). Pedicle tension was found to decrease perforator flap survival and its detrimental effect was exacerbated by twisting. Surgeons need to have a lower threshold for correction of pedicle tension when twisting is combined than without a twist.