Objective: To investigate the clinical effect of the reserve-flow anterolateral thigh perforator flap based on aesthetics concept to repair soft tissue defect around the knee joint. Methods: From June 2016 to April 2017, 10 patients with skin and soft tissue defects around the knee joint were admitted to Mingzhou Hospital of Zhejiang University. The area of the soft tissue defects around the ankle were ranged from 5.0 cm × 3.0 cm to 11.0 cm × 7.5 cm after debridement. The anterolateral thigh perforator flaps were designed on the ipsilateral lateral thigh, according to the results of preoperative perforator detection. The reserve-flow anterolateral thigh perforator flaps based on aesthetic concept were used to repair the wound through the subcutaneous tunnel. The flaps were 5.5 cm × 3.5 cm to 12.0 cm × 8.0 cm in size. The donor sites were directly closed. Results: The flaps of 9 patients completely survived, however, epidermal necrosis occurred to 1 patient, at the distal end of the flap, about 1 cm × 1 cm in size. It completely healed after dressing change for 1 week. The follow up time was from 8 to 15 months (mean 12 months). The flaps were satisfactory in appearance, good in the elasticity, nearly normal in color, and had protective sensation. The two-point discrimination perception ranged from 9 to 13 mm(mean 10 mm). The donor and recipient sites only remained linear scars, with no depression deformity. The lower limb functions were normal. Conclusions The reverse-flow anterolateral thigh flap based on aesthetic concept, is an alternative method to repair the soft tissue defect around the knee joint, and protect the donor site to the maximum extent.