Incisional Management in the Multiply Operated Total Knee Arthroplasty

Total knee arthroplasty in the setting of multiple previous skin incisions can be a complex clinical scenario for the arthroplasty surgeon. Inappropriate incision choice can lead to devastating complications such as skin necrosis and its sequelae, including periprosthetic joint infection and the need for flap reconstruction. It is therefore critical for knee surgeons to understand the blood supply to the anterior aspect of the knee to prevent adverse outcomes. This article challenges some of the long-held dogma regarding incisional management for total knee arthroplasty and utilizes case examples to demonstrate that skin necrosis between parallel incisions can be avoided by utilizing an existing lateral incision with full-thickness subfascial skin flaps.