Wound complications following total knee arthroplasty are infrequent but they can lead to skin necrosis and complex soft tissue defects with possible exposure of bone and/or hardware and high risk of periprosthetic infection. When wound complications occur, prompt management is mandatory. There is much controversy regarding the optimal management of wound necrosis around a total knee. Local wound care, debridement, fasciocutaneous, muscle and perforator flaps have been differently used. Muscle coverage remains the standard to which all other flaps should be compared, especially in infected wounds. Perforator flaps have recently represented a true revolution in the soft tissue reconstruction around the knee, with peculiar advantages due to their low donor morbidity and long pedicles.