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Recently, the reverse-flow (distally based) anterolateral thigh flap has been used for soft tissue reconstruction around the knee [1-5], and it has several advantages such as a long pedicle, a sufficient amount of tissue, possible composite transfer with fascia lata and minimal donor site morbidity [1]. However, this flap has a risk of venous congestion from the reverse blood flow and resistance of the venous valves [2-4]. This might cause the development of flap failure. In the cases of flap-threatening venous congestion after the reconstruction of an oncologic defect of the knee with reverse-flow anterolateral thigh island flap, the authors performed venous supercharge using the greater saphenous vein with a reliable vessel diameter and salvaged the flap successfully. We present the clinical considerations in the salvage of a venous con-