summary TKA Wound Complications may occur as a result of patient underlying systemic factors, prior surgery to the knee, or direct trauma post-operatively. Diagnosis is made clinically with presence of incisional breakdown or dehiscence. Treatment depends on the size of the wound, thickness of the wound, and the limb vascular status. Epidemiology Risk factors systemic factors diabetes mellitus vascular disease inflammatory arthritides such as rheumatoid arthritis certain medications (immunosuppressives) tobacco use poor nutritional status albumin <3.5g/dL total lymphocyte count <1,500/uL perioperative anemia morbid obesity (BMI >40 kg/m^2) local factors previous incisions skin bridges should be >5-6cm avoid crossing previous skin incisions at an angle <60 degrees use most lateral incision possible knee deformity skin adhesions poor local blood supply technique large subcutaneous skin flaps short incisions requiring vigorous skin traction not preserving subcutaneous fat layer long surgical time long tourniquet time postoperative hematoma infection early (first 4 days) knee flexion beyond 40 degrees in a high risk knee Presentation History multiply operated knee prior infection Symptoms persistent knee pain persistent drainage beyond the early postoperative period (7 days) Physical exam wound breakdown erythema warmth drainage peri-incisional eschar Imaging Radiographs may help rule-out deep infection. looks for bone resorption Bone scan radionuclide studies if infection suspected but aspiration and serology not confirmatory Angiography if flow through sural arteries in question and gastrocnemius flap planned Treatment Nonoperative local wound care +/- antibiotics indications may be appropriate for some small superficial wounds patients who are not surgical candidates Operative debridement and coverage with rotational flap indications full-thickness necrosis medial gastrocnemius rotational flap (medial sural artery): anterior and medial defects lateral gastrocnemius rotational flap (lateral sural artery): lateral defects