Catastrophic skin necrosis after total knee arthroplasty: a case report and review of the literature.

Introduction and importance: There have been few cases of post total knee arthroplasty (TKA) skin necrosis reported. Here, the authors present our patient with skin necrosis post TKA on account of its extreme rarity, considerable risk factors, and importance of its treatment. Case: This is a cautionary report on the rule of including previous single longitudinal incision in surgical approach. The authors included previous medial incision in ours and performed arthroplasty through medial parapatellar incisions. After noticing skin necrosis in front of patella, reoperation including flap and skin graft was done, leading to complete recovery. Clinical discussion: While skin necrosis post TKA is not common, it can be present in high-risk patients who should be considered for a decrease in their risk factors. Preoperatively, underlying diseases should be under control. Intraoperation risk factors, in particular incision selection, and considerations about lateral retinacular release are important. Conclusion: A balance must be achieved between the ability to expose the knee through a prior incision and avoiding extensive undermining of the subcutaneous flaps in patients with previous knee surgery. It may be a better approach to ignore medial incisions and use the classic midline incision.