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The results of 12 patients who had been treated with muscle flap coverage for compromised soft tissues associated with total knee arthroplasty were studied. Five latissimus dorsi free flaps, 6 medial gastrocnemius rotational flaps, and 2 rectus abdominis free flaps were done in 12 knees. The authors used and classified 3 types of muscle flaps: (1) prophylactic soft tissue coverage, done before definitive reconstruction; (2) treating muscle flap for infected prostheses with deficient soft tissue coverage; and (3) salvage muscle flap for wound dehiscence or necrosis in the immediate postoperative period. These patients were observed for an average of 4.1 years (range, 1–8 years). The wound was revascular-ized successfully in 100% of the knees. The prosthesis was preserved in 83% of the knees. Recurrent infection occurred in 3 patients. Treating muscle flaps are least likely to result in an overall successful reconstruction because these flaps are used in knees with chronic infection. Prophylactic flaps and salvage muscle flaps provide the soft tissue coverage necessary to allow successful reconstruction in the appropriate circumstances.