PURPOSE Compression therapy post lower limb free flap surgery can mitigate venous congestion, reduce oedema, and prevent chronic lymphedema. It can improve flap contour and expedite return to function without increasing flap failure rates. Despite its increasing use, its efficacy lacks quantitative validation which this study addresses. METHODOLOGY This case series includes 5 male patients (average age: 37 years) who underwent lower limb free flap reconstruction post-trauma (anterolateral thigh n=3, radial forearm n=1, vastis lateralis n=1). Compression therapy was initiated approximately 3 weeks postoperatively, considering pedicle location and leading edge of the flap. Dressing windows allowed for monitoring. Compression intensity was increased every 3 days as tolerated. High-stretch bandages transitioned to low-stretch bandages as mobility increased. Circumferential measurements were taken before and during therapy over months, at the free flap and at various anatomical landmarks. RESULTS After a mean 3-month follow-up, significant contour improvement was observed with a mean 5.2% circumferential reduction of the free flap; 6.4%, 5.2%, and 4% reduction at metatarsal head, arch, and heel circumference. A 6.2% and 4.9% increase in circumference at 15cm and 20cm proximal to the malleolus respectively indicated calf muscle hypertrophy. No flap complications occurred and all patients returned to work within the follow-up period contributing to improved quality of life. CONCLUSION Compression therapy following lower limb free flap surgery exhibits positive effects, reduces the need for additional procedures such as liposuction, and accelerates return to function.