The anatomy research of descending branch of the LCF artery especially connecting with lateral superior genicular artery allow expanded indication of distally based ALT Flap for reconstructive around knee. Aims of study was to describe the technical of distally based ALT flap harvest and review use of distally based ALT Flap. Results: 10 patients successfully with distally based ALT. Size of the flap average 8.1 x 18.9cm. Length of the pedicle average 12.38cm. In all cases, there are 6 good flaps, 2 flaps were died because of small and injury perforator during rotation the flap, skin graft after
2 flaps have small remote necrosis but natural healing and closing the skin directly. In conclusion, the size of distally based ALT flap is large, the pedicle is almost consistently, the flap used to cover large defect from thigh, around knee to leg.