We report a case of reconstruction with a free flap for a post deep burn ulcer with an exposed patella. Bone or tendon is located directly below the skin in the lower extremity, especially around the knee, and blood flow around the knee is unstable. Therefore, intractable ulcers are not uncommon. There are many methods for reconstructing defects of the lower extremities such as direct closure, skin grafting, local flaps, and free flaps. When considering free flap transfer for knee defects, recipient vessel selection is the main challenge. We selected the descending genicular artery as the recipient vessel and applied a latissimus dorsi free flap to cover the defect. The flap survived without notable complications. One year after the operation, the patient was able to walk without difficulties in daily life. The descending genicular artery is useful as the recipient vessel in reconstruction with free flaps in patients with lower limb trauma.
