The saphenous neurovascular free flap

A new neurovascular free-flap donor area on the medial side of the knee is described. The flap is supplied by the saphenous artery, a branch of the descending genicular artery. It is drained both by the long saphenous vein and by the saphenous venae comitantes. Its nerve supply is from the medial femoral cutaneous nerve above the knee and the saphenous nerve below the knee. The flap is thin, has a long vascular pedicle (up to 15 cm) and a dependable nerve supply, and can be made quite large. The principal disadvantage is the donor wound, which requires grafting in most cases. We describe the anatomy of the saphenous flap, the method of raising it, and our early clinical experience with it both as a free flap and as a pedicled flap. Potential uses of the saphenous flap and its broader significance in relation to flaps on the lower extremity are briefly discussed.