The first anatomic description of the distal medial thigh as a donor site for free flaps was given in 1981 by Acland and coworkers (Acland et al., Plast Reconstr Surg 67:763, 1981). In their paper, the authors focused on the saphenous artery as the nutrient vessel for skin flaps raised from a large area over the medial aspect of the knee. Since this first description, this saphenous flap, which later was named the descending genicular artery perforator flap, has been used as a soft tissue flap for local defect cover as a pedicled flap or as a free flap at many other sites, such as the distal extremities and the head and neck (Karamürsel and Çelebioglu, Plast Reconstr Surg 117:1308–1314, 2006; Koshima and Soeda, Ann Plast Surg 26(3):284–288, 1991). Although this donor site allows harvesting of thin skin flaps with a long pedicle, anatomic variations of the saphenous artery and its branches to the skin, along with the need to transect the saphenous tendon and to skin-graft the donor site in wider flaps, have limited its clinical use. Already in this first report, besides the saphenous artery, Acland et al. mentioned a musculoarticular branch but did not pay attention to it (Acland et al., Plast Reconstr Surg 67:763, 1981). Later, this branch became the most important vessel for flap harvesting at the distal medial thigh.