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Individual potential to develop deep vein thrombosis shares a similar pathophysiologic mechanism with intravascular thrombosis formation in the lower extremity venous system, but has not yet been studied in relation to venous insufficiency following free flap procedures. The aim of this study was to investigate the association between potential for deep vein thrombosis as measured by the Caprini Risk Assessment Model and venous insufficiency in microsurgical lower extremity reconstruction.The authors conducted a retrospective review of all free flap procedures performed on the lower extremities at their institution between January of 2005 and April of 2014. Patients were divided into two groups consisting of those with or without venous insufficiency, and the association between venous insufficiency and Caprini score was analyzed. Receiver operating characteristic curve analysis was used to estimate the cutoff Caprini point that best discriminated between the two groups.Of a total 170 flaps with 24 cases of venous insufficiency, the difference in median Caprini score between the two groups was statistically significant (p = 0.03). These results were consistent with those of subgroup analysis in the deep vein recipient group. Receiver operating characteristic analysis revealed that patients with Caprini scores of 7 or higher had significantly increased odds ratios for venous insufficiency. History of sepsis (<1 month) and immobilization were significantly associated with venous insufficiency according to a multivariate regression model.The authors detected a strong association between individual deep vein thrombosis potential as measured by the Caprini Risk Assessment Model and venous insufficiency following microsurgical lower extremity reconstruction.Risk, III.