© 2020 by the authors. Inertial microfluidic technology, which can manipulate the target particle entirely relying on the microchannel characteristic geometry and intrinsic hydrodynamic effect, has attracted great attention due to its fascinating advantages of high throughput, simplicity, high resolution and low cost. As a passive microfluidic technology, inertial microfluidics can precisely focus, separate, mix or trap target particles in a continuous and high-flow-speed manner without any extra external force field. Therefore, it is promising and has great potential for a wide range of industrial, biomedical and clinical applications. In the regime of inertial microfluidics, particle migration due to inertial effects forms multiple equilibrium positions in straight channels. However, this is not promising for particle detection and separation. Secondary flow, which is a relatively minor flow perpendicular to the primary flow, may reduce the number of equilibrium positions as well as modify the location of particles focusing within channel cross sections by applying an additional hydrodynamic drag. For secondary flow, the pattern and magnitude can be controlled by the well-designed channel structure, such as curvature or disturbance obstacle. The magnitude and form of generated secondary flow are greatly dependent on the disturbing microstructure. Therefore, many inventive and delicate applications of secondary flow in inertial microfluidics have been reported. In this review, we comprehensively summarize the usage of the secondary flow in inertial microfluidics.