Open lower extremity musculoskeletal injuries that require soft tissue reconstruction carry significant risks of complications, including flap failure, infection, and nonunion. These complications predispose patients to worse physical, psychological, and economic outcomes and negatively impact quality of life. Teaching based on the work of Marko Godina suggests that flap reconstruction performed within 72 hours of injury reduces major complications. However, contemporary studies incorporating advances in negative pressure wound therapy suggest that flap reconstruction within 7 days may provide comparable outcomes. Barriers to early flap coverage in the United States include delayed transfers and a lack of national guidelines on timing.