The medial gastrocnemius muscle flap is a versatile surgical technique widely used in for limb reconstruction to treat soft tissue defects around the knee and leg. Medial gastrocnemius muscle flap is arguably the most useful flap for soft tissue coverage of the leg and knee. The harvesting technique is straightforward, does not require microsurgery and its vascularization pattern is reliable. This flap can be utilized in various conditions, such as wound closure following infected total knee prostheses, reconstruction of soft tissue defects around the knee, and defects caused by trauma, tumors, and infections in the knee area. The medial gastrocnemius muscle flap provides safer soft tissue coverage for defects in revision knee arthroplasty. Additionally, modifications such as combined transfer with the hemi-soleus muscle have been described for reconstructing larger defects. Despite its high efficacy, the medial gastrocnemius muscle flap can present certain challenges due to donor site morbidity and its high volume, often requiring additional procedures such as skin grafting. While the medial gastrocnemius muscle flap is commonly used, its limited length and distal volume may necessitate alternative approaches for the proximal or lateral knee. Overall, medial gastrocnemius muscle flap remains a reliable choice for soft tissue coverage in orthoplastic procedures, and ongoing research focuses on optimizing its use and outcomes.