A new, pedicled, reverse flow osteoperiosteal flap based on 2 branches of the descending genicular a. is presented. Both a periosteal and osteoperiosteal flap can be raised at the distal end of the femur and, in favourable cases (64% of the dissections), transported as far as the middle third of the leg. In all other cases the proximal third of the tibia can be reached. Composite musculo-osteoperiosteal flaps can also be raised, including the articularis genus m. Clinical applications may include the treatment of nonunions, reconstruction of segmental tibial defects and bone revascularisation in aseptic necrosis about the knee joint.