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Background:. Soft tissue knee defects are frequently seen in surgical practice. The saphenous artery (SA)-based flap is a management option with variable suggested donor sites. The present study describes the use of an SA-based flap harvested from the posteromedial aspect of the leg in management of soft tissue knee defects. Methods:. The present study recruited 30 patients with soft tissue knee defects due to miscellaneous causes. All patients were treated with an SA-based flap harvested from the posteromedial aspect of the leg. All patients were followed up for 6 months. Outcome parameters included flap survival, flap complications, and restoration of knee function. Results:. After 6 months of follow-up, all flaps survived; the reported complications were distal flap necrosis (6.7%), wound dehiscence (6.7%), seroma (3.3%), and small contracture band (3.3%). All patients restored normal range of motion around the knee. Conclusion:. An SA-based flap harvested from the posteromedial aspect of the leg is a feasible, safe, and effective option for management of soft tissue knee defects.