[Objective] To explore the prevention and treatment of incision complications after complex total knee arthroplasty with gastrocnemius myocutaneous flap. [Methods] Twelve patients with complex TKA incision treated with ipsilateral gastrocnemius myocutaneous flap in the Department of Osteoarticular surgery of the first affiliated Hospital of Jinan University from 2014 to 2019 were analyzed retrospectively. the average follow-up time was 2.8 years. KSS knee joint score scale was used to evaluate the postoperative function and measure the range of motion of the affected limb during the latest follow-up. According to the different ways of incision treatment, the patients were divided into preventive group and therapeutic group, and then independent sample t-test was performed. [Result] The patients in both groups completed the operation successfully, and there were no serious complications such as important vascular and nerve injury during the operation. There was no significant difference in the duration of skin flap operation, the amount of blood loss, the days of rehabilitation and hospitalization between the two groups (P > 0.05). According to the grade of wound healing, 11 patients healed in grade A and 1 patient in therapeutic flap group healed in grade B. The average time of suture removal was 18.9 days. In the last follow-up, there was no special discomfort in the area covered by the flap in 2 cases, decreased sensation in the covered area of the flap in 8 cases, and intermittent mild Anterior Knee Pain in 2 cases. The KSS score was excellent in 8 cases and good in 4 cases ,85.67 ±8.73 in average , while the average ROM of the affected limb was 116.67 °±13.54 °.During the last follow-up, the KSS score of the preventive flap group was better than that of the therapeutic flap group (t = 2.240, P < 0.05) and the difference is statistically significant. But the difference of ROM (t = 1.939, P > 0.05) was not statistically significant. [Conclusion] Transposition of ipsilateral gastrocnemius myocutaneous flap to cover the wound can effectively prevent and treat complications of complex TKA incision and improve the success rate of operation and patient satisfaction as well. Compared with the therapeutic flap, the use of prophylactic skin flap can improve the function of the affected limb after operation.