i'iddian N. .1. et al. suggested (hat lateral approach is sale and may .mu-a better outcome than (hat through the medial capsule for the replaeetnea! of vaigus-knees (89).

•                              Table (3) Recommendations for skin incisions                                \

1.    Midline incision is best.                                                                                                                                ,

2.    Use previous skin incisions.

3.    It    is   usually   sale   to   ignore   short   medial    or   lateral    parapatcliar   skin incisions.

4.   Beware of wide scars with thin or absent subcutaneous tissue, as damage to the underlying dermal plexus is likely.

5.   If long parallel skin incisions exist, choose the lateralmost incision, if favorable. to avoid a large lateral skin ilap.

6.   In complex, situations (burns, trauma, radiation, multiple skin incisions), consult
j_ _ a 'plastic surgeon.                 ______________ __________ __ __          j

————— ---••=

Soft tissue expansion has been used successfully in patients undergoing primary arthroplasty, conversion of arra.dnoucsrs, iuir/rplantation, and revision total knee arthroplasty (go)._________

Alternative exposures used in primary total knee arthroplasty such as the subvastus, midvastus, and lateral approaches generally will not provide adequate exposure for a revision operation and should not be used (87).

Skin necrosis can be avoided by selecting the appropriate incision and dissecting deep to the fascia (91).

Extensile exposure by dissection of scar, quadriceps snip or turndown, tibial tubercle osteotomy, or medial epicondylar osteotomy should be performed early to prevent patellar tendon disruption (91).

in certain cases, the distal femur can be exposed circumferentially by using a quadriceps myocutaneous flap or femoral peel. Special care should be taken with the infected or ankylosed knee (91).

Exposure may be critical, especially if the knee is stiff. Avulsion of the patellar tendon is difficult to treat and has a poor prognosis. Removal of