Traumatic lower extremity reconstruction defined by Godina (1986) recommends free flap coverage within 72 hours of injury. Complications in the delayed period (> 72 hrs) were 17.5% (infection) and 12% (flap loss). We hypothesized that definitive debridement, optimal dressing care, meticulous planning, and anastamoses outside the zone of injury would permit delayed reconstruction. Retrospective review of 14 Gustillo grade IIIb, lower extremity reconstructions was undertaken for: mechanism and concomitant injuries; number of pre-flap operations; VAC dressing; timing from injury to flap to discharge; length of hospitalization; transfer or primary admission; pre-operative vascular studies; minor and major complications; and follow up. 71% had significant associated injuries. Average time to flap was 22 days. 85% of patients utilized VAC dressing after debridement. All patients underwent extremity CT angiogram prior to free flap. Three minor (21%) and one major (7%) complication occured. Minor complications were small areas of skin graft loss and a donor site hematoma. The major complication, a late osteomyelitis (9 months), resolved. No free flaps failed. Average follow up was 28 weeks.Our data indicate reconstruction of Gustillo grade IIIb lower extremity injuries can be safely and reliably performed after 72 hours without an increase in flap loss or complications.