The work aims to introduce the recent advances on perforation-mediated modified atmosphere packaging (PM-MAP), and provide certain ideas and basis for the application of PM-MAP in the preservation of fruits and vegetables. This paper presents an overview on the application of PM-MAP in the preservation of fruits and vegetables, focuses on the key factors affecting gas exchange through perforation, and the effects of O2 and CO2 and humidity in perforation-mediated packaging. Furthermore, the effects of PM-MAP technology on nutritional quality, flavor and microorganism of packaged fruit and vegetable products are highlighted, and further research prospects and challenges are prospected. PM-MAP effectively avoids the anaerobic environment in packaging, maintains the quality of fruits and vegetables and extends the shelf life. With the increasing demand for fresh and ready-to-eat fruits and vegetables, the development of PM-MAP is accelerated. In particular, perforation has a broad research prospect in the active packaging.