•Lower extremity free flap reconstruction cases have a higher failure rate than those in other anatomic regions.

•The use of anticoagulation in the perioperative period may decrease the risk of some of the reasons for flap failure, side-effects may include a greater risk of complications.

• A standardized protocol for anticoagulation in lower extremity free flap that minimizes risks and maximizes benefits would improve patient outcomes.

•We evaluated complication rates associated with various anticoagulation protocols to determine whether one is superior to another.